Radiology for the surgeon. Case 11. Presentation. Midgut volvulus.
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Female↗
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Results for “Intestinal Volvulus”
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[Retro-costo-xyphoid hernia in adults. Apropos of 3 cases].
Three cases of retrosternal diaphragmatic hernia (Morgagni hernia) are reported. Diagnosis have been made by conventional radiology (Chest X-ray, Upper G-I series) in 2 cases: the third one was found incidentally during a laparotomy. Peritoneography, CT scan, NMR are recommended in the difficult cases. ONe case presented as acute gastric outlet obstruction secondary to an intra-thoracic volvulus of the herniated stomach. Surgical treatment is indicated in all cases of retrosternal diaphragmatic hernia because of the high-risk of complications (gastric volvulus, colonic obstruction). Surgery through an abdominal approach is preferred and post-operative course is benign.
Adult↗
Ischemia/reperfusion injury of the ascending colon in ponies: a correlative study utilizing microvascular histopathology and corrosion casting.
Volvulus of the ascending colon (ACV) in the horse results in microvascular injury and necrosis of the intestinal mucosa. This study investigated the site and type of microvascular injury which occurs within the mucosa and submucosa following ACV. Histopathology of volvulus treated ponies demonstrated mucosal necrosis with microvascular hemorrhage and thrombosis. Thrombi occurred within the subepithelial capillaries and edema and hemorrhage developed throughout the mucosa and submucosa. Vascular casts allowed 3-D viewing of samples obtained from the entire pelvic flexure and demonstrated two distinct microvascular changes: 1) disruption of the colonic glandular capillary network occurred concomitantly with the mucosal injury, and 2) extensive endothelial leakage from the submucosal microvasculature contributes to edema formation. Thus, microcorrosion casting of the equine pelvic flexure provided an effective means to characterize the location and severity of vascular leakage and visualize the extent and severity of injury to the capillary network not easily depicted by histopathology. Microvascular casting in conjunction with routine histopathology provided additional information on the pathomorphologic changes in this model of ischemia/reperfusion injury.
Animals↗
Combination of "patch, drain, and wait" and home total parenteral nutrition for midgut volvulus with massive ischemia/necrosis
The successful use of a combination of "patch, drain, and wait" (PDW) and home total parenteral nutrition (TPN) in the management of a case of acute, catastrophic midgut volvulus in a 2-year-11-month-old boy with near-total ischemia/necrosis of his small intestine is reported. The PDW approach to the highly effective management of acute midgut ischemia/necrosis in infancy and childhood (necrotizing enterocolitis and midgut volvulus) involves maximum gut salvage by avoidance of resection, stoma formation, or both through the use of extensive peritoneal cavity drainage by Penrose drains, TPN, and broad-spectrum antibiotics. The extensive peritoneal drainage fosters capture of enteric fistulas with the formation of enterostomies at drain exit sites, while adhesions and ischemia/inflammation-induced hypervascular obliteration of the peritoneal cavity diminish the potential for peritonitis (no peritoneal cavity, no peritonitis) and facilitate impressive salvage of seemingly hopelessly lost ischemic/necrotic gut (a simulation of the in utero ischemic gut process leading to atresias and some varying, but generally mild, gut loss) while simultaneously contributing to the resorption of absolutely non-salvageable gut and the creation of a remarkably clean and adhesion-free peritoneal cavity resembling that of a newborn infant with midgut intestinal atresia.
Journal Article↗
Combination of "patch, drain, and wait" and home total parenteral nutrition for midgut volvulus with massive ischemia/necrosis.
The successful use of a combination of "patch, drain, and wait" (PDW) and home total parenteral nutrition (TPN) in the management of a case of acute, catastrophic midgut volvulus in a 2-year-11-month-old boy with near-total ischemia/necrosis of his small intestine is reported. The PDW approach to the highly effective management of acute midgut ischemia/necrosis in infancy and childhood (necrotizing enterocolitis and midgut volvulus) involves maximum gut salvage by avoidance of resection, stoma formation, or both through the use of extensive peritoneal cavity drainage by Penrose drains, TPN, and broad-spectrum antibiotics. The extensive peritoneal drainage fosters capture of enteric fistulas with the formation of enterostomies at drain exit sites, while adhesions and ischemia/inflammation-induced hypervascular obliteration of the peritoneal cavity diminish the potential for peritonitis (no peritoneal cavity, no peritonitis) and facilitate impressive salvage of seemingly hopelessly lost ischemic/necrotic gut (a simulation of the in utero ischemic gut process leading to atresias and some varying, but generally mild, gut loss) while simultaneously contributing to the resorption of absolutely non-salvageable gut and the creation of a remarkably clean and adhesion-free peritoneal cavity resembling that of a newborn infant with midgut intestinal atresia.
Abdomen, Acute↗
[Detection of parasites and symptoms of parasitic diseases. 2: Parasites of the gastrointestinal tract, tissue and organ parasites, ecto- and skin parasites].
Intestinal parasites are Giardia lamblia, Cryptosporidium parvum, Entamoeba histolytica, hookworms, ascaris, tape worms and others. As to organ parasites, their life-threatening courses are pointed out: amebiasis in the intestine, liver, lung and brain, toxoplasmosis in the brain, lung and heart muscle, including the danger for the child of a pregnant woman with an acute infection, West African sleeping sickness with encephalitis, the East African form with polyserositis, South American Chagas' disease with intestinal and myocardial involvement, visceral leishmaniasis Kala Azar, the filariasis Onchocerca volvulus with threatening blindness, the dog tapeworm with cysts and Echinococcus multilocularis with carcinoma-like infiltration of the liver and other organs, cysticercosis of the brain, eye and muscle tissue; partly generalizing parasitoses in immuno-suppressed including AIDS patients, finally skin parasites as causes of disease (e.g. scabies), and as potential carriers of pathogens.
Diagnosis, Differential↗
Internal hernia with gastric outlet obstruction.
A patient with an unusual type of internal hernia was treated successfully. To our knowledge, this is the first reported case of a hernia emanating through the gastrohepatic ligament that resulted in gastric outlet obstruction. It is even more remarkable because, although the small bowel was the herniated viscus, the symptoms were due to obstruction of the stomach rather than obstruction of the small bowel.
Female↗
[Two rare complications of percutaneous endoscopic gastrostomy: obstruction of the pylorus and gastrocolic fistula occurring in one patient].
UNLABELLED: We report an 10 month old male infant, who developed an obstruction of the pylorus by dislocation of the retention disk 5 months after percutaneous endoscopic gastrostomy (PEG). This could be corrected under endoscopic control. Two years after PEG insertion diarrhoe occurred immediately after feeding caused by a gastrocolic fistula with dislocation of the retention disk in the colon transversum. An excision of the fistula and a resection of the colon segment were performed successfully. CONCLUSION: In patients with PEG and unclear abdominal symptoms a tube dislocation has to be kept in mind at any time.
Colon↗
Neonatal gastric volvulus secondary to rectal atresia.
The "upside-down stomach" is a rare form of organo-axial neonatal volvulus, which occurs because of absent or attenuated anatomical anchors and abnormal motility of the stomach. It is considered a surgical emergency that requires immediate correction. We report a previously undescribed etiology of gastric neonatal volvulus caused by an extremely distended transverse colon, secondary to rectal atresia. The etiologic and diagnostic considerations are discussed. Gastropexy in the form of gastrostomy proved to be an effective treatment.
Humans↗
Experience with 103 cases of intestinal gangrene in Ile-Ife, Nigeria.
One hundred and three patients with intestinal gangrene were managed in Ile-Ife, Nigeria over a 10-year period. The overall mortality in the series was 25.2%. Strangulated hernias were responsible for 65 cases (63%), intussusception 20.4%, adhesions 11.7% and volvulus 2.9%. Avoidable deaths resulted from anastomotic breakdown and inadequate preoperative fluid therapy. Primary intestinal resection and end-to-end anastomosis of large bowel involved in gangrene gave very good results. It was found to be quite safe and economical, and avoided the inconveniences and complications of a colostomy.
Adult↗
Regional enteritis of the duodenum.
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Adolescent↗
[Stomal stenosis following gastrectomy in the elderly].
Seven hundred and thirty seven patients over 65 years of age (mean 76 years) undergoing gastrectomies from 1979 to 1991 were reviewed to evaluate the cause of stomal stenosis in the early postoperative period. Fifty seven (7.7%) patients, 24 males (5.6%) and 33 females (10.6%), had overt stomal stenosis or obstruction documented by radiological and endoscopic findings. The incidence of stenosis in females was significantly higher than in males (p < 0.05). Complications developed in 19 (20.0%) of 95 patients after gastroduodenostomy (Billroth-I), 29 (6.2%) of 465 after gastrojejunostomy (Billroth-II and others) and 8 (5.0%) of 159 after esophagojejunostomy (total gastrectomy). The incidence of complications in the first was significantly higher than in the other two (p < 0.01). The cause of stomal stenosis was classified into three groups; (1) transient stenosis due to stomal edema in 21 patients, (2) intestinal obstruction immediately adjacent to the stoma (kinking, invagination and volvulus) in 22, (3) organic stenosis of pathological origin (stomal ulcer, anastomotic leakage and strangulation by the proliferated mesocolon) in 14. The period of recovery from postgastrectomy retention was different in each group. It was 20.7 (mean) +/- 7.7 (SD) days in group (1), 29.7 +/- 12.6 days in group (2) and 62.1 +/- 30.0 days in group (3). These mean periods were significantly different from each other (p < 0.01). Group (1) and most of group (2) responded well to conservative management consisting of decompression by nasogastric suction and parenteral feeding but a reoperation was necessary for only two patients in group (2). Half of group (3) was treated by endoscopic dilatation and one third by reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Treatment of sigmoid volvulus: experience in Gondar, north-west Ethiopia.
A retrospective study of 145 patients with sigmoid volvulus (SV) seen over a three year period is presented. Sigmoid volvulus (SV) was the commonest cause of emergency admissions with intestinal obstruction (56%). The mean age was 55 +/- 13 years, (range 10-80), and the male to female ratio was 13.5:1. The presence or absence of a previous attack makes a significant difference in the occurrence of gangrenous bowel. Eighteen out of 75 patients (24%) with no previous attack had gangrenous bowel compared with 2 out of 57 (4%) after recurrence. A conservative sigmoidoscopic detorsion was successful in the majority of the cases (63%). Elective surgery after bowel preparation was associated with a mortality rate of 3% in comparison to 12.5 mortality rate in patients with viable bowel operated on an emergency basis (p < 0.05). Sigmoidoscopic detorsion should be the first measure in patients with viable bowel.
Adult↗
[Problems of omphalocele and gastroschisis].
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Abdomen↗
The influence of schistosomiasis on the serum concentrations of retinol and retinol binding protein of a rural population in Liberia.
121 persons from rural areas of central Liberia were examined for possible interactions between helminthic infections and the retinol (vitamin A) and retinol binding protein (= RBP) status. About 2/3 of this mainly adult population had retinol and RBP serum concentrations less than or equal to 400 micrograms/l and less than or equal to 40 micrograms/ml, respectively. Only one person had a serum retinol concentration less than 100 micrograms/l which is critical for the appearance of xerophthalmia. The retinol and RBP concentrations showed a linear, positive correlation. 19 parasitologically helminth free individuals had mean serum retinol and RBP concentrations of 414 micrograms/l and 43 micrograms/ml, respectively, while the corresponding values of 20 individuals with schistosomiasis as the only helminthic infection were 339 micrograms/l and 35 micrograms/ml. 65 other persons with mixed intestinal and/or tissue helminthiases, and 9 persons with pure Onchocerca volvulus infection exhibited intermediate mean concentrations. 32 persons without serological evidence of helminthic infections had higher serum concentrations of retinol and RBP than 32 individuals in whose sera at least one raised antibody titer was found in the enzyme-linked immunosorbent assay with 3 different helminthic test antigens. In addition to age, sex and pregnancy schistosomiasis might be a further risk factor of latent retinol and RBP deficiency among adults and teenagers living in a schistosomiasis endemic area.
Adolescent↗
[Two cases of postero-lateral diaphragmatic hernia (congenital Bochdalek hernia) revealed at adult age by severe complications. Operation and cure. Review of the literature (author's transl)].
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Adult↗
Ivermectin in loiasis and concomitant O. volvulus and M. perstans infections.
Two clinical studies were carried out in Gabon, Africa to evaluate the efficacy, safety, and tolerability of ivermectin in the treatment of patients with Loa loa infection. In the first study, 35 patients received single oral doses of ivermectin, 5-200 mcg/kg body weight. Blood microfilariae levels did not decrease after a single oral 5, 10, 30, or 50 mcg/kg dose of ivermectin, but levels did decrease after doses of 100, 150, and 200 mcg/kg. The most efficacious dose was 200 mcg/kg; mean blood microfilariae levels decreased to 12% of mean pretreatment values by day 15 and remained decreased for 28 days. A second study evaluated the safety and efficacy of ivermectin in patients with multifilarial infections. All 17 patients had concomitant Loa loa and O. volvulus infection. M. perstans affected 5 of the patients. Sixteen patients also had infections due to intestinal nematodes. The patients each received single oral doses of 200 mcg/kg ivermectin. Ten days later, the mean Loa loa blood microfilariae level had decreased to 20% of the mean pretreatment level. O. volvulus dermal microfilariae densities were reduced to 2% of the pretreatment levels. A minimal increase in blood microfilaria levels was observed on day 28. In contrast, dermal microfilariae levels remained near zero for the duration of the study. Intestinal infection due to Ascaris was eradicated in all of the affected patients by day 23; efficacy against Trichuris and hookworm infections, however, was poor. All patients tolerated ivermectin well including those with multiple infections.
Adult↗