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PubMed2000

Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction.

Bilious vomiting in newborns is an urgent condition that requires the immediate involvement of a team of pediatric surgeons and neonatologists for perioperative management. However, initial detection, evaluation and treatment are often performed by nurses, family physicians and general pediatricians. Bilious vomiting, with or without abdominal distention, is an initial sign of intestinal obstruction in newborns. A naso- or orogastric tube should be placed immediately to decompress the stomach. Physical examination should be followed by plain abdominal films. Dilated bowel loops and air-fluid levels suggest surgical obstruction. Contrast radiography may be required. Duodenal atresia, midgut malrotation and volvulus, jejunoileal atresia, meconium ileus and necrotizing enterocolitis are the most common causes of neonatal intestinal obstruction.

Duodenum↗
PubMedDate not supplied

Small bowel herniation around an anterior gastropexy for a gastric volvulus: a case report.

Gastric volvulus can be a medical emergency with life-threatening complications. Early surgical intervention is important to avoid potential ischemic complication that may lead to infarction of the stomach. The condition has been reported in children and in the elderly, but the majority of cases are reported in the fifth decade of life. We present a case of a complication arising from corrective laparoscopic surgery for gastric volvulus, whereby most of the small bowel herniated around the anterior laparoscopically performed gastropexy. The herniation was reduced during a laparotomy, and the space through which the herniation occurred was closed.

Aged↗
PubMed2000

Sigmoid volvulus after laparoscopic cholecystectomy. An unusual complication.

Laparoscopic cholecystectomy has become the standard surgical technique for treating symptomatic gallbladder disease. Intestinal obstruction after laparoscopic cholecystectomy is unusual. We present the case of a 37-year-old man who underwent routine laparoscopic cholecystectomy for cholelithiasis using an American four-port technique. He was well 24 h postoperatively and was discharged. He presented 36 h later with clinical features of bowel obstruction. A sigmoid loop was seen on a plain abdominal radiograph. Laparotomy revealed distension of the large and small bowel to the level of the rectosigmoid junction and a sigmoid volvulus. This was reduced by releasing adhesions to lengthen the sigmoid mesentery. A primary sigmoid resection and anastomosis was not attempted due to luminal discrepancy and lack of bowel preparation. The patient underwent interval sigmoid colectomy 2 weeks later. A sigmoid volvulus following laparoscopic cholecystectomy has not been previously reported. It may be related to the induction of the pneumoperitoneum, combined with the lateral tilt of the table and a long redundant sigmoid colon. This case expands the range of potential complications associated with laparoscopic cholecystectomy and illustrates the need for continued vigilance after apparently routine procedures.

Adult↗
PubMed1990

Delayed onset of intestinal obstruction in children after unrecognized seat belt injury.

The increased use of child safety seats and seat belt restraints has significantly reduced the incidence of severe head injuries associated with motor vehicular accidents. However, an increase in the number of both acutely recognized intestinal perforations and delayed obstructions due to ischemic strictures has been noted. This report describes two children with delayed onset of intestinal obstruction related to the "seat belt syndrome" who presented with bilious emesis 3 to 6 weeks following an unrecognized lap belt injury. At laparotomy, a volvulus around an omental band adherent to a resolving traumatic mesenteric hematoma was the basis of the obstruction in both cases. The volvulus resulted in a stricture in each instance that required resection and end-to-end anastomosis. The diagnosis of posttraumatic intestinal obstruction should be suspected in children who develop nausea and bilious emesis following motor vehicular accidents in which they were wearing lap belts.

Abdominal Injuries↗
PubMed1999

The northern exposure sign: a newly described finding in sigmoid volvulus.

OBJECTIVE: Previous studies of sigmoid volvulus have focused on the migration and dilatation of the sigmoid with respect to both fixed and mobile landmarks in the abdomen. None has specifically referred to the relationship of this colonic segment to the more proximal large intestine. We analyzed findings on abdominal radiographs, all of which had been obtained with the patient supine, of sigmoid volvulus, with particular attention to the juxtaposition of the sigmoid colon with the transverse colon. MATERIALS AND METHODS: The abdominal radiographs of 30 patients with clinically confirmed sigmoid volvulus were obtained from the teaching files of four hospitals and were retrospectively reviewed. These radiographs were compared with abdominal radiographs of 28 individuals, each of whom had a dilated colon but not sigmoid volvulus. All radiographs had been obtained with the patient in the supine position. RESULTS: The transverse colon was identified in 26 of the 30 patients with sigmoid volvulus. In each of these 26 patients, the sigmoid colon was cephalad to the transverse colon. Of the patients in the control group, the transverse colon was identified in 24 of the 28 patients. In none of these control group patients did the sigmoid colon extend rostral to the transverse colon. Thus, this sign had a sensitivity of 86% and a specificity of 100%. CONCLUSION: A dilated sigmoid colon that ascends cephalad to the transverse colon is a newly described and accurate finding of sigmoid volvulus on abdominal radiographs obtained with the patient supine.

Case-Control Studies↗
PubMed1998

Intestinal rotational abnormalities in polysplenia and asplenia syndromes.

OBJECTIVE: To review the anomalies of intestinal rotation occurring in association with asplenia (right isomerism) and polysplenia (left isomerism) syndromes. MATERIALS AND METHODS: A retrospective study was performed of 27 children with asplenia (21) or polysplenia (6) identified from the cardiology and radiology databases from 1988 to 1996 and in whom an upper gastrointestinal barium study had been performed. The intestinal rotation was determined by reviewing the barium meal and could be divided into four groups: (1) normal rotation, (2) incomplete rotation or nonrotation, (3) reversed rotation and (4) reversed incomplete rotation or nonrotation. Surgical correlation was obtained at laparotomy in 17 patients. RESULTS: Of the 27 children studied, 3 (11 %) had normal rotation; incomplete rotation or nonrotation occurred in 5 (19 %), and 2 in this group developed midgut volvulus; 5 (19 %) had reversed rotation; 14 (52 %) had reversed incomplete rotation or nonrotation. CONCLUSION: Asplenia and polysplenia are frequently associated with intestinal malrotation, and a barium study is recommended in all of these children, as many will be at risk of midgut volvulus.

Abnormalities, Multiple↗
PubMed2003

Antenatal small-bowel volvulus without malrotation: ultrasound demonstration and discussion of pathogenesis.

We present a case of volvulus without malrotation in a twin fetus where serial antenatal US assisted in the diagnosis and ensured prompt postnatal surgical treatment. When a fetal subumbilical intestinal mass is seen, changing its echogenicity from complex to cystic, and associated with progressive proximal small-bowel obstruction and/or bowel perforation, small-bowel volvulus should be included in the differential diagnosis.

Diseases in Twins↗
PubMed1980

Organoaxial volvulus of the stomach and volvulus of the sigmoid colon.

The management of a patient in whom both organoaxial volvulus of the stomach and volvulus of the sigmoid colon had occurred is described. Anterior gastropexy was successful in preventing recurrence of the gastric volvulus. The angulation and distortion of the stomach so produced may have been responsible for the development of a benign gastric ulcer.

Humans↗
PubMed1986

Diagnosis and management of intestinal obstruction in individuals with cancer.

Small bowel obstructions, which account for two-thirds of all intestinal obstruction, are caused by adhesions, hernias and cancer. Large bowel obstructions are usually the result of a malignancy, but may also be caused by diverticulitis or volvulus. Previously treated individuals with a known diagnosis of advanced cancer originating in the pelvis are at highest risk for developing intestinal bowel obstruction. Since 30 percent of Americans will develop cancer in their lifetimes, and colorectal cancer is the most common type, this represents a significant population at risk to be followed by nurse practitioners. The pathophysiology, assessment and management of an individual with a bowel obstruction is reviewed. Morbidity and mortality in this population is high. Wound healing problems, including infection, dehiscence, evisceration and fistula formation, contribute significantly to the morbidity and can cause long-term problems. In today's health care system, it's likely that patients will be discharged from the hospital earlier after bowel surgeries. Therefore, nursing care focusing on wound management is outlined.

Humans↗
PubMed2006

Intestinal obstruction during pregnancy.

Intestinal obstruction is a rare cause of acute abdominal pain during pregnancy. We reviewed and analyzed the medical records of four pregnant women with intestinal obstruction, treated at the Department of Surgery in the Kaohsiung Medical University Hospital during a period of 19 years, between June 1984 and December 2002. Their ages ranged from 22 to 35 years (mean, 28 yrs). Three cases had had prior lower abdominal surgery. Adhesion was the unique finding in all four patients during the operation. Enterolysis was needed to release the intestinal obstruction in three of the patients; the fourth required resection and anastomosis of the ileum as a result of volvulus. Premature labor was prevented with tocolysis in two patients. The results of this study lead us to emphasize the importance of close observation and early surgery to avoid intestinal strangulation if a pregnant woman who develops intestinal obstruction has an old surgical scar on her abdomen. Premature labor may be avoided with tocolysis.

Adult↗
PubMed1989

Chronic gastric torsion in infancy: a revisited diagnosis.

Twenty out of 108 infants with vomiting, who underwent an upper gastrointestinal X-ray study during a period of 2 years, showed a peculiar shape and position of the stomach already described as chronic gastric torsion. We examined clinical, radiologic and laboratory findings of these 20 infants. Our results showed that chronic gastric torsion is frequently associated with gastroesophageal reflux and has a wide spectrum of symptoms, complications and nutritional abnormalities.

Female↗
PubMed1990

Sigmoid volvulus in pregnancy.

Sigmoid volvulus is uncommon in the U.K. and more so in pregnancy. A case of sigmoid volvulus in pregnancy with a rare successful conclusion by conservative management is described and discussed, with a review of the literature. Sigmoid volvulus in the U.K. accounts for only 0.9% of all cases of intestinal obstruction, with most cases occurring in the elderly. Intestinal obstruction in pregnancy is also uncommon, with a reported incidence varying between 1 in 3,600 maternities to 1 in 66,431 maternities. A case is reported which was successfully treated conservatively.

Adult↗