RESUMEN
Enteric duplication has cystic and tubular varieties. A male infant presented with a large cystic, well-demarcated mass in the right flank. On exploratory laparotomy, multiple cystic and tubular lesions were present adjacent to the mesenteric border of the small bowel along with malrotation of the small bowel. The tubule-cystic structure was excised along with the involved normal bowel segment and Ladd's procedure was performed. Histopathological evaluation revealed an intestinal duplication cyst. The occurrence of midgut malrotation and volvulus along with duplication is uncommon. The cyst's substantial size could have been an aetiological factor for malrotation and volvulus. The child's small bowel had adapted remarkably with time. This case highlights a new variant of duplication cysts.
Asunto(s)
Vólvulo Intestinal , Humanos , Masculino , Lactante , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/diagnóstico , Intestino Delgado/anomalías , Intestino Delgado/cirugía , Intestino Delgado/patología , Quistes/cirugía , Laparotomía/métodos , Anomalías del Sistema Digestivo/cirugía , Anomalías del Sistema Digestivo/complicaciones , Anomalías del Sistema Digestivo/diagnóstico por imagenRESUMEN
RATIONALE: Small bowel volvulus (SBV) is a rare cause of acute abdominal pain in adults, which requires surgical intervention to prevent small bowel necrosis. Primary SBV is rare, and its preoperative diagnosis is challenging. This report describes a case of primary SBV diagnosed preoperatively and treated laparoscopically. PATIENT CONCERNS: A 56-year-old man presented complaining of sudden-onset abdominal pain of 3-hour duration. Physical examination revealed tenderness in periumbilical and upper abdominal regions with no signs of peritonitis. DIAGNOSIS: Contrast-enhanced computed tomography revealed a 360°-clockwise rotation of the small intestine when viewed caudally at the mesenteric base. At this region, the superior mesenteric vein was interrupted. Although no dilation of the small intestine was observed, increased density in the mesentery of the affected area was observed. Minimal ascites was observed in the pelvic cavity. No evidence of congenital or secondary SBV was observed, supporting the diagnosis of primary SBV. INTERVENTIONS: Laparoscopic detorsion of the SBV was performed approximately 6 hours after the onset of symptoms. No signs of bowel necrosis were observed, and the procedure was concluded after releasing the torsion. OUTCOMES: Severe abdominal pain disappeared immediately after surgery. The postoperative course was uneventful, and the patient was discharged on the 8th postoperative day. LESSONS: This case highlights the importance of preoperatively diagnosing SBV, which enables early laparoscopic devolvulation without bowel resection.
Asunto(s)
Vólvulo Intestinal , Intestino Delgado , Laparoscopía , Humanos , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/diagnóstico , Masculino , Persona de Mediana Edad , Laparoscopía/métodos , Intestino Delgado/cirugía , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiología , Dolor Abdominal/diagnósticoRESUMEN
BACKGROUND Reversed intestinal malrotation is an extremely rare disease, with an incidence of 1 in 250 000. In Japan, application of robotic-assisted colorectal cancer surgery is expected to increase. There are no reports of robot-assisted surgery for cecal cancer with reversed intestinal malrotation. CASE REPORT An 84-year-old Japanese man with epigastric pain and abdominal distention was referred to our hospital's Department of Gastroenterology for thorough examination. Colonoscopy revealed a semicircumferential type 2 tumor in the cecum and ascending colon. Gastrografin contrast study showed that the large intestine was entirely on the patient's right side and the small intestine was shifted to the left side. Contrast-enhanced computed tomography revealed enlarged lymph nodes near the tumor, and masses were observed at the liver, which were believed to be metastases. Following examination, reversed intestinal malrotation and concurrent cecal cancer was diagnosed. The patient was referred to our department for surgery and underwent robot-assisted ileocecal resection with D3 lymphadenectomy. The postoperative course was favorable, and patient was discharged on the sixth postoperative day, without complications. According to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma 9th edition, the pathological diagnosis was pT4b (ileum), pN1b, cM1a (H1 [grade A]), and pStage IVa cancer. After considering tumor stage and patient's overall condition in consultation with his family, we decided against palliative systemic therapy. The patient was provided with best supportive care. CONCLUSIONS Robot-assisted surgery might be useful in manipulation of the dissection of adhesions, owing to its capacity for high-resolution 3-dimensional imaging and forceps manipulation, using articulated functions.
Asunto(s)
Neoplasias del Ciego , Procedimientos Quirúrgicos Robotizados , Humanos , Masculino , Neoplasias del Ciego/cirugía , Neoplasias del Ciego/complicaciones , Anciano de 80 o más Años , Vólvulo Intestinal/cirugía , Anomalías del Sistema Digestivo/cirugía , Anomalías del Sistema Digestivo/complicaciones , Adenocarcinoma/cirugía , Adenocarcinoma/complicacionesRESUMEN
AIM: Intestinal malrotation (IM) represents a rare congenital anomaly in adults, although it is more common during infancy. This condition originates during embryonic development due to incomplete rotation of the midgut around the superior mesenteric vessels. The primary aim of this case study is to emphasize the importance of surgeon awareness and recognition of this congenital anomaly during laparoscopic gastric surgery to avoid serious complications. CASE PRESENTATION: A 45-year-old male presented to the clinic with a complaint of vague epigastric pain for two months. The patient underwent a comprehensive clinical evaluation, including laboratory tests, endoscopic examination, and radiological imaging. The diagnostic workup revealed early-stage gastric cancer. Incidentally, radiological studies also demonstrated a congenital non-rotation of the small bowel. Given the patient's congenital anatomical anomaly, a laparoscopic total gastrectomy was performed employing a reversed C-shaped Roux-En-Y limb reconstruction. Postoperative recovery was uneventful, and the patient was discharged in stable condition. RESULTS: The patient was doing well at the 2-year follow-up, there were no complications related to the form of anastomosis, and the pathological result was comparable to that of patients with non-rotating small bowls. CONCLUSIONS: Intestinal malrotation is an uncommon asymptomatic congenital abnormality in adults. During laparoscopic gastric surgery, the surgeon should identify this anomaly to optimize surgical approaches, particularly during anastomosis formation. Accurate identification and appropriate management of intestinal malrotation are crucial to mitigate potential postoperative complications, including twisting, obstruction, tension, and anastomosis leak.
Asunto(s)
Gastrectomía , Laparoscopía , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/complicaciones , Masculino , Gastrectomía/métodos , Laparoscopía/métodos , Persona de Mediana Edad , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/complicaciones , Vólvulo Intestinal/etiología , Anomalías del Sistema Digestivo/cirugía , Anomalías del Sistema Digestivo/complicaciones , Anomalías del Sistema Digestivo/diagnóstico por imagen , Anastomosis en-Y de RouxRESUMEN
BACKGROUND: Intussusception with intestinal malrotation is termed as Waugh's syndrome. The incidence of Waugh's syndrome is less than 1%. There are very few reported cases. Once presented, it is a pediatric surgical emergency. CASE PRESENTATION: We present here two cases of Waugh's syndrome: an 11-month-old male patient of Punjabi descent and a 4-month-old female patient of Afghan descent who presented to us with abdominal pain and bleeding per rectum. Abdominal sonography revealed an intussusception with a target sign. They were explored and perioperatively had intestinal malrotation alongside intussusception, thus a diagnosis of Waugh's syndrome was made. A right hemicolectomy and Ladd's procedure was performed. CONCLUSION: Waugh syndrome is a rare congenital anomaly but can present with vague abdominal symptoms. Once presented, it is a pediatric surgical emergency. The patient should be optimized followed by surgical exploration.
Asunto(s)
Intususcepción , Humanos , Intususcepción/cirugía , Intususcepción/diagnóstico por imagen , Masculino , Femenino , Lactante , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/complicaciones , Vólvulo Intestinal/diagnóstico por imagen , Enfermedades del Ciego/cirugía , Enfermedades del Ciego/complicaciones , Enfermedades del Ciego/diagnóstico por imagen , Quistes/cirugía , Quistes/complicaciones , Quistes/diagnóstico por imagen , Dolor Abdominal/etiología , Colectomía , Ultrasonografía , Síndrome , Ciego/anomalías , Ciego/cirugía , Ciego/diagnóstico por imagenRESUMEN
BACKGROUND: A volvulus refers to the torsion or rotational twisting of a portion of the gastrointestinal tract, with a predilection for impacting the caecum and sigmoid colon, often resulting in the development of bowel obstruction. The risk factors associated are old age, chronic fecal impaction, psychiatric disorders, colonic dysmotility, prior abdominal surgical procedures, diabetes, and Hirschsprung's disease. Elderly are most commonly affected with sigmoid volvulus but there are few cases among young adults that culminate in grave complications. Although it is rare, but young individuals presenting with acute abdomen secondary to sigmoid volvulus need urgent attention. To prevent more invasive surgical procedures, endoscopic detorsion is preferred nowadays with complete recovery of patients. We present a case of young female who was successfully managed with endoscopic detorsion. CASE PRESENTATION: 27 years old Asian Pakistani female presented with worsening abdominal distention, constipation and vomiting since 2 days. On examination she was afebrile, vitally stable. Abdomen was distended, tympanic percussion with generalized tenderness. Abdominal radiograph was obtained which showed dilated bowel loops followed by Computed tomography of abdomen which was suggestive of Sigmoid volvulus causing intestinal obstruction. Patient was immediately moved to endoscopy unit and endoscopic detorsion of volvulus was done. For individuals who present with sigmoid volvulus and do not exhibit signs of peritonitis or colonic gangrene, the recommended course of action involves acute endoscopic detorsion, followed by scheduled surgical intervention. CONCLUSION: This case report emphasizes the significance of clinicians considering sigmoid volvulus as a rare but important cause when evaluating abdominal pain in young and otherwise healthy patients. A delay in diagnosis and treatment extending beyond 48 hours leads to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.
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Vólvulo Intestinal , Enfermedades del Sigmoide , Humanos , Femenino , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/complicaciones , Adulto , Enfermedades del Sigmoide/cirugía , Enfermedades del Sigmoide/complicaciones , Tomografía Computarizada por Rayos X , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Resultado del Tratamiento , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/etiologíaAsunto(s)
Obstrucción Intestinal , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/cirugía , Enfermedades del Sigmoide/diagnóstico por imagen , Enfermedades del Sigmoide/etiología , Vólvulo Intestinal/diagnóstico por imagen , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/complicacionesRESUMEN
In this article, we present case reports of two patients admitted to the University Hospital in Pilsen for acute abdomen due to a disorder of the passage through the gastrointestinal tract (GIT). Both were indicated for surgery. The patients were diagnosed intraoperatively with rarely occurring cecal volvulus (CV). The findings required an ileocecal resection; nevertheless, both patients fully recovered despite the need the resection.
Asunto(s)
Abdomen Agudo , Enfermedades del Ciego , Vólvulo Intestinal , Humanos , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/diagnóstico por imagen , Vólvulo Intestinal/complicaciones , Abdomen Agudo/etiología , Enfermedades del Ciego/cirugía , Enfermedades del Ciego/complicaciones , Enfermedades del Ciego/diagnóstico por imagen , Enfermedades del Ciego/diagnóstico , Masculino , Ileus/cirugía , Ileus/etiología , Ileus/diagnóstico por imagen , Femenino , Persona de Mediana Edad , AncianoRESUMEN
PURPOSE: Intestinal malrotation, characterized by abnormal intestinal positioning, can lead to severe complications like volvulus and internal hernias, especially in neonates and children. Our aim was to evaluate the diagnostic methods, treatment results and postoperative follow-up of pediatric patients treated for intestinal malrotation. METHODS: This retrospective study reviewed medical records of pediatric patients who underwent surgery for intestinal malrotation between January 2013 and January 2022. Data on demographics, symptoms, diagnostic approaches, surgical interventions, and postoperative outcomes were analyzed. RESULTS: The study included 45 patients, with a male predominance (68.8%). Ages ranged from 1 day to 15 years, averaging 1.54 years. Presenting symptoms were acute abdomen (n = 21) and chronic abdominal pain with vomiting (n = 24). Diagnoses were established via physical exams and imaging, including upper gastrointestinal contrast studies and abdominal ultrasonography. All patients received the Ladd procedure, with some requiring necrotic bowel resection due to volvulus. CONCLUSION: The diagnosis and management of pediatric intestinal malrotation present significant challenges due to its variable symptoms and potential for life-threatening complications. Early and accurate diagnosis, followed by appropriate surgical management, is crucial. This study emphasizes the importance of diligent postoperative follow-up to identify and mitigate complications, particularly in younger and severely affected patients.
Asunto(s)
Anomalías del Sistema Digestivo , Vólvulo Intestinal , Humanos , Masculino , Estudios Retrospectivos , Femenino , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/diagnóstico , Preescolar , Lactante , Niño , Adolescente , Recién Nacido , Anomalías del Sistema Digestivo/cirugía , Anomalías del Sistema Digestivo/complicaciones , Anomalías del Sistema Digestivo/diagnóstico , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiologíaRESUMEN
Managing colon cancer with intestinal nonrotation, a type of congenital intestinal malrotation, is challenging due to the presence of anatomical abnormalities and severe adhesions. When patients have nonrotation, it is markedly more difficult to determine which vessels correspond to the colic vessels and ileal vessels until all vascular branching patterns become evident. The optimal approach for right-sided colon cancer with intestinal nonrotation has yet to be established. In the present case of ascending colon cancer with intestinal nonrotation, we performed laparoscopic right hemicolectomy with D3 dissection using a modified cranial approach. This approach involves tracing, without resecting, branches from the superior mesenteric vein and superior mesenteric artery in a cranial-to-caudal manner until the ileocolic artery and ileocolic vein, which course toward the cecum, are identified, followed by the dissection of the colic vessels and lymph nodes in a caudal-to-cranial fashion.
Asunto(s)
Colectomía , Neoplasias del Colon , Humanos , Neoplasias del Colon/cirugía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/patología , Colectomía/métodos , Masculino , Laparoscopía/métodos , Adenocarcinoma/cirugía , Adenocarcinoma/complicaciones , Adenocarcinoma/patología , Anciano , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/complicaciones , Anomalías del Sistema Digestivo/cirugía , Anomalías del Sistema Digestivo/complicaciones , FemeninoAsunto(s)
Antipsicóticos , Clozapina , Vólvulo Intestinal , Humanos , Clozapina/efectos adversos , Vólvulo Intestinal/inducido químicamente , Vólvulo Intestinal/diagnóstico por imagen , Vólvulo Intestinal/cirugía , Antipsicóticos/efectos adversos , Masculino , Esquizofrenia/tratamiento farmacológico , Enfermedades del Ciego/inducido químicamente , AdultoRESUMEN
OBJECTIVES: Colonic volvulus is a common cause of bowel obstructions and surgery is the definitive treatment. Functional status is often associated with adverse postoperative outcomes but its effect on colectomy for volvulus remained under-explored. This study sought to analyze the effect of functional status on the 30-day outcomes of colectomy for volvulus. MATERIALS AND METHOD: National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Only patients with volvulus as the primary indication for colectomy were included. Thirty-day postoperative outcomes were compared between patients with dependent functional status (DFS) and independent functional status (IFS), adjusted for demographics, baseline characteristics, preoperative preparation, indication for surgery, and operative approaches by multivariable logistic regression. RESULTS: There were 1,476 patients with DFS (945 partially DFS and 531 fully DFS) and 8,824 (85.67 %) IFS patients who underwent colectomy for volvulus. After multivariable analysis, DFS patients had higher risks of mortality (aOR=1.671, 95 CI=1.37-2.038, p < 0.01), pulmonary complications (aOR=2.166, 95 CI=1.85-2.536, p < 0.01), sepsis (aOR=1.31, 95 CI=1.107-1.551, p < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR=1.436, 95 CI=1.269-1.626, p < 0.01), discharge not to home (aOR=3.774, 95 CI=3.23-4.411, p < 0.01), and 30-day readmission (aOR=1.196, 95 CI=1.007-1.42, p = 0.04). Moreover, DFS patients had a longer length of stay (p = 0.01). CONCLUSION: DFS was identified as an independent risk factor for increased mortality and complications after colectomy for volvulus. Given the substantial overlap between DFS patients and those who have colonic volvulus, these insights can contribute to preoperative risk assessments and postoperative care in these patients.
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Colectomía , Vólvulo Intestinal , Complicaciones Posoperatorias , Humanos , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/mortalidad , Vólvulo Intestinal/complicaciones , Colectomía/efectos adversos , Colectomía/mortalidad , Femenino , Masculino , Persona de Mediana Edad , Anciano , Estados Unidos/epidemiología , Factores de Riesgo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/etiología , Factores de Tiempo , Estudios RetrospectivosRESUMEN
INTRODUCTION: Colon volvulus is the twisting of a segment of colon on its mesenteric axis, which can lead to the obstruction of the lumen and the blood supply. Colon volvulus is common in "volvulus belt" countries and can involve the sigmoid (60-70%) and cecum (25-40%). CASE PRESENTATION: We report a case of a 47-year-old male, Alawites, who presented with bowel obstruction and dilated abdomen without any specific abdominal pain. Abdominal laparotomy showed both sigmoid and cecum volvulus with no signs of perforation or ischemia. DISCUSSION AND CONCLUSION: One of the possible risk factors of sigmoid colon volvulus is the length of the rectum and sigmoid, while mobile cecum is considered as a possible reason for cecum volvulus. The management remains controversial and is specific for every case, depending mainly on the vitality of the colonic walls and the general condition of the patient.
Asunto(s)
Colon Sigmoide , Vólvulo Intestinal , Humanos , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/diagnóstico por imagen , Vólvulo Intestinal/complicaciones , Masculino , Persona de Mediana Edad , Colon Sigmoide/diagnóstico por imagen , Colon Sigmoide/cirugía , Colon Sigmoide/patología , Enfermedades del Ciego/cirugía , Enfermedades del Ciego/diagnóstico por imagen , Enfermedades del Sigmoide/diagnóstico por imagen , Enfermedades del Sigmoide/cirugía , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico por imagen , Ciego/diagnóstico por imagen , Ciego/patología , Laparotomía , Resultado del TratamientoRESUMEN
BACKGROUND: The Ladd procedure is the treatment of choice for patients with intestinal malrotation; however, the long-term outcomes of the laparoscopic Ladd procedure are not well documented. This study aimed to review the presentation, management, and outcomes of adult patients who underwent a laparoscopic Ladd procedure. METHODS: A retrospective review was conducted to identify adult patients with malrotation who underwent a laparoscopic Ladd procedure between January 1995 and June 2022 at the Mayo Clinic in Rochester, Minnesota. Patient details and follow-up data were obtained from the electronic medical records. Patients were invited to participate in a structured phone interview to assess symptoms and quality of life (QoL). RESULTS: A total of 44 patients underwent the laparoscopic Ladd procedure. Of the 44 patients, 42 (95.5 %) were symptomatic, with 7 (16.7 %) presenting with acute symptoms. Moreover, 8 laparoscopic procedures (13.6 %) required conversion to an open procedure. The median estimated blood loss was 20 mL (IQR, 10-50), operative time was 2.3 h (IQR, 1.8-2.8), and hospital length of stay was 2 days (IQR, 2-3). Postoperative ileus was the most common complication (18.0 %). The median follow-up was 8.00 years (IQR, 2.25-13.00), with more than 90.0 % of patients having partial or complete symptom resolution. Of note, 28 patients (63.6 %) completed phone interviews. Moreover, 1 patient (2.0 %) reported a postoperative volvulus. When asked to compare their current symptoms with those preoperatively, 78.6 % of patients noted that they were significantly better. Furthermore, 85.7 % of patients reported that their QoL was significantly better after surgery. Finally, 96.4 % of patients would recommend the procedure to a friend or family member with the same condition. CONCLUSION: The laparoscopic Ladd procedure is a safe and effective surgical procedure for adult patients with intestinal malrotation.
Asunto(s)
Vólvulo Intestinal , Laparoscopía , Calidad de Vida , Humanos , Laparoscopía/métodos , Laparoscopía/efectos adversos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/diagnóstico , Resultado del Tratamiento , Tempo Operativo , Tiempo de Internación/estadística & datos numéricos , Conversión a Cirugía Abierta/estadística & datos numéricos , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Anomalías del Sistema DigestivoRESUMEN
Multiple endocrine neoplasia type 2B is a rare autosomal dominant disease characterized by the presence of medullary thyroid carcinoma, pheochromocytoma, Marfan-like fatigue, a peculiar face with thickening of the lips, mucosal neuromas on the lips and tongue, and gastrointestinal phenomena. Most patients harbor pathological variants of the RET gene. Herein, we present the first case of a 14 year-old boy who experienced small intestinal volvulus along with a megacolon, and he was diagnosed with multiple endocrine neoplasia type 2B. The patient complained of constipation since he was 2 years old and slowly progressive abdominal distension at school age. At 14 years of age, he presented with remarkable megacolon mimicking Hirschsprung's disease and complicated with small intestinal volvulus. The volvulus was successfully repaired, and the particularly dilated transverse colon was resected following a rectal biopsy. Histopathological evaluation of the resected transverse colon revealed to be compatible with ganglioneuromatosis. After emergency surgery, the patient was diagnosed with multiple endocrine neoplasia type 2B with medullary thyroid carcinoma, and a de novo variant of RET was confirmed. Gastroenterologists should consider it when treating patients with constipation, especially those with megacolon. Therefore, timely diagnosis may lead to appropriate treatment of medullary thyroid carcinoma and improve mortality.
Asunto(s)
Vólvulo Intestinal , Megacolon , Neoplasia Endocrina Múltiple Tipo 2b , Neoplasias de la Tiroides , Humanos , Neoplasia Endocrina Múltiple Tipo 2b/complicaciones , Neoplasia Endocrina Múltiple Tipo 2b/diagnóstico , Neoplasia Endocrina Múltiple Tipo 2b/patología , Neoplasia Endocrina Múltiple Tipo 2b/cirugía , Masculino , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/complicaciones , Adolescente , Megacolon/complicaciones , Megacolon/cirugía , Megacolon/etiología , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Estreñimiento/etiología , Proteínas Proto-Oncogénicas c-ret/genética , Carcinoma Neuroendocrino/complicaciones , Carcinoma Neuroendocrino/cirugía , Carcinoma Neuroendocrino/patología , Ganglioneuroma/complicaciones , Ganglioneuroma/cirugía , Ganglioneuroma/patología , Ganglioneuroma/diagnóstico , Intestino Delgado/patologíaRESUMEN
BACKGROUND Jejunal diverticulosis are false diverticula of the small bowel that form from outpouching of the mucosa and submucosa. They are pulsion diverticula that are often asymptomatic and can be found incidentally during surgery. In some instances, jejunal diverticula could result in intestinal obstruction. Small intestinal volvulus is an uncommon cause of small bowel obstruction that results in a closed loop obstruction and is an indication for emergent surgical intervention. CASE REPORT We report a case of an 84-year-old man who presented to the Emergency Department with abdominal pain and generalized weakness. A preoperative computerized tomographic scan demonstrated a closed loop small bowel obstruction with mesenteric swirling. The patient was taken for a diagnostic laparoscopy, which revealed extensive proximal jejunal diverticulosis and a volvulus of the involved jejunum. An exploratory laparotomy was warranted for safe detorsion of the small bowel and resection of the diseased segment. The small bowel was successfully detorsed, with resection of the involved jejunum. Intestinal continuity was established by a primary side-to-side anastomosis. CONCLUSIONS Jejunal diverticula have been reported in the literature as a cause of small bowel obstructions, and very few reports exist of concurrent small bowel volvulus. In very rare instances, both of these conditions can coexist. There should be prompt surgical intervention in all cases of closed loop small bowel obstructions to prevent intestinal ischemia, perforation, and sepsis.
Asunto(s)
Divertículo , Obstrucción Intestinal , Vólvulo Intestinal , Intestino Delgado , Enfermedades del Yeyuno , Anciano de 80 o más Años , Humanos , Masculino , Divertículo/complicaciones , Divertículo/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Vólvulo Intestinal/etiología , Vólvulo Intestinal/cirugía , Intestino Delgado/anomalías , Enfermedades del Yeyuno/cirugía , Enfermedades del Yeyuno/complicaciones , Enfermedades del Yeyuno/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.
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Fístula Intestinal , Humanos , Femenino , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Niño , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Cuerpos Extraños/diagnóstico por imagen , Imanes/efectos adversos , Síndromes de Malabsorción/etiología , Síndromes de Malabsorción/diagnóstico , Enfermedades del Yeyuno/etiología , Enfermedades del Yeyuno/cirugía , Enfermedades del Yeyuno/diagnóstico , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/etiología , Vólvulo Intestinal/diagnóstico , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugíaAsunto(s)
Vólvulo Intestinal , Síndrome de Rubinstein-Taybi , Humanos , Enfermedades del Ciego/diagnóstico , Enfermedades del Ciego/cirugía , Enfermedades del Ciego/complicaciones , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/cirugía , Enfermedades del Íleon/complicaciones , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/complicaciones , Vólvulo Intestinal/cirugía , Síndrome de Rubinstein-Taybi/complicaciones , Síndrome de Rubinstein-Taybi/diagnósticoRESUMEN
BACKGROUND: Malrotation and volvulus classically present with bilious vomiting. It is more common earlier in life, but there are other causes of bile-stained vomiting. This leads some clinicians to 'watch and wait'. In the presence of a volvulus, this is potentially a fatal decision. It is not clear from the literature if there is a safe time window in which children can be observed in the hope of avoiding transfers or radiological investigations. AIM: To determine whether time to identification and management of midgut volvulus correlated with morbidity and mortality; and whether there were patterns to transition of care. METHODS: Multicentre, retrospective review of all children with malrotation ± volvulus at two tertiary children's hospitals in Brisbane from 2000 to 2012. Data collected included age at presentation, timing between symptom onset and presentation, radiological findings, and definitive surgical management. Outcomes included patient length of stay (LOS), total parenteral nutrition (TPN) duration, re-operations and death. RESULTS: There were 96 cases of malrotation identified, with 23 excluded (elective operation, insufficient data). Neonates made up 66% of included cases. Only 14% of cases were over 12 months old. Bilious vomiting or bile-stained aspirates were the presenting symptoms in 71% (52). Overall mortality was 5.56%. Time from symptom onset to presentation or management was not significantly associated with morbidity or mortality. More than half (53%, 39/73) of patients received total parenteral nutrition; 20/39 for more than 10 days. Neonates and infants had a significantly higher rate of TPN compared with older children (P < 0.001). Those requiring TPN post-operatively had a significantly higher mortality compared with those who did not (P = 0.02). Time from symptom onset to presentation or definitive management was not significantly associated with LOS, TPN duration, or need for re-operation. CONCLUSION: Malrotation remains a time-critical diagnosis to secure and treat. Even a short duration of symptoms can be associated with high morbidity or mortality. There is no place for 'watch and wait' for such patients, and malrotation/volvulus should be emergently actively excluded with contrast studies.