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Meconium ileus
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Robert J. Vandewalle, Frederick J. Rescorla
Complicated cases include instances of volvulus, bowel perforation, intestinal atresia, and giant cystic meconium peritonitis. Volvulus usually occurs when the distended segment of ileum twists at the level of the narrow, pellet-filled, distal small intestine (Figure 37.5a). In some cases, volvulus can result in bowel perforation, leading to meconium peritonitis, and, in others, the bowel may become necrotic and liquefy, resulting in a pseudocyst (i.e. giant cystic meconium peritonitis (Figure 37.5b)). Bowel atresias are thought to arise when the base of the volvulus becomes ischemic (Figure 37.5c). Contrast enema studies will not reflux into the dilated segment of small intestine in any of these scenarios (Figure 37.5d).
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
How will you treat the volvulus?If the patient has no features of bowel ischaemia or perforation, I would decompress it with a flexible sigmoidoscope and flatus tube. This is successful in about 75% of cases with a 2.5% complication rate.This approach converts an emergency into an elective situation and also allows assessment of the viability of the colonic mucosa. I would leave the flatus tube in situ for 1–3 days to allow continued decompression and prevent recurrence until a definitive procedure can be carried out.The risk of recurrence is up to 90% with detorsion alone, so a definitive procedure should be considered once the patient has been adequately resuscitated ideally within 2 days of initial decompression. If fit, these patients can generally undergo a safe laparoscopic sigmoid resection and primary anastomosis at an appropriate interval.
Colonic Volvulus
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Colonic volvulus is the third leading cause of bowel obstruction worldwide. Populations most affected live in Africa, the Middle East, India, and Russia, which together are known as the “volvulus belt.” The population in this region tend to be affected at a younger age (40–50) compared to Western countries, and as such tend to be healthier (Heis et al., 2008). In the United States, volvulus accounts for 10%–15% of colonic obstruction behind diverticulitis and colon cancer, and is responsible for 1%–20% of intestinal obstructions. The cause is thought to be related to a mobile portion of bowel that twists around a fixed base or mesentery, creating a closed-loop obstruction. The most common site of colonic volvulus involves the sigmoid (60.9%), followed by the cecum (34.5%), transverse (3.6%), and splenic flexure (1%) (Ballantine et al., 1985). In the United States, it is more common in the elderly population, with risk factors including previous volvulus, abdominal surgery, institutionalization, megacolon, and chronic constipation (Gingold and Murrell, 2012). These differences in demographics necessitate caution when interpreting management described from outside one's geographic region. There are no randomized control trials to guide decision management in the setting of acute colonic volvulus. However, several patterns of practice have developed as a result of describing the care of this patient population.
Sigmoid volvulus: a rare but unique complication of enteric fever
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Muhammad Sohaib Asghar, Abubakar Tauseef, Hiba Shariq, Maryam Zafar, Rumael Jawed, Uzma Rasheed, Mustafa Dawood, Haris Alvi, Saad Aslam, Marium Tauseef
Patients of Sigmoid Volvulus usually present with constipation, diarrhea, vomiting, abdominal distention, tense and tender abdomen, bright red blood in the stool, and sluggish gut sounds. On digital rectal examination, the rectum may be empty or may contain fresh blood in it [8]. It is an acute surgical emergency because on a very narrow window period it makes complications more likely which may range from gut ischemia, gangrenous bowel segment, peritonitis, shock, sepsis, and even perforation [9]. Making a diagnosis of sigmoid volvulus depends on clinical signs as well as imaging modalities. X-Ray abdomen may show dilated sigmoid colon, air-fluid levels or coffee bean sign [10]. Barium enema shows tapering of bowel lumen as a bird’s beak sign, but it is generally not carried out in patients with the risk of impending gut ischemia or perforation. Computed tomographic scan (C.T scan) is the latest modalities of interest, may show horseshoe sign, omega sign, coffee bean sign, whirl pattern, steel pan sign, and inverted V or U sign [10–12].
In the Experimental Model of Acute Mesenteric Ischemia, The Correlation of Blood Diagnostic Parameters with the Duration of Ischemia and their Effects on Choice of Treatment
Published in Journal of Investigative Surgery, 2019
Mikail Cakir, Dogan Yildirim, Fatma Sarac, Turgut Donmez, Semih Mirapoglu, Adnan Hut, Fazilet Erozgen, Omer Faruk Ozer, Melih Ozgun Gecer, Leyla Zeynep Tigrel, Oguzhan Tas
Ketamine hydrochloride (50 mg/kg) and xylazine (5 mg/kg) were administrated intraperitoneal for general anesthesia. Laparotomy was performed on rats with a 2.5-cm incision. The superior mesenteric artery was dissected only in the Sham group. In the Volvulus group, volvulus was formed by twisting 3 cm of the intestinal segment around the distal segment. In the remaining three groups, SMA was dissected and ligated with 3/0 silk, and mesenteric ischemia was formed. Mesenteric ischemia was identified by the change of the intestinal segment's color, lack of pulse, and verified with a Doppler ultrasound. To prevent fluid and heat loss, the rat's abdomens were closed. After dissection of the Sham group, and 2, 4, and 6 hr later for the remaining groups, a second laparotomy was performed, and 3 cc intracardiac blood was obtained. In the Volvulus group, the volvulus segment was sampled for histopathological examination. In all other groups, the intestinal segment was sampled and resected according to proximal and distal borders of the demarcation line. Intracardiac blood was drawn to create hypovolemic shock and rats were sacrificed.
Chilaiditi syndrome—a clinical conundrum!
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
Supriya Dsouza, Yuvraj Mhaske, Adarsh Kulkarni, Ajit Baviskar
The appropriate diagnosis of this condition is extremely important as other entities in the differential diagnosis may require exploratory laparotomy for management, whereas the treatment for this syndrome is generally conservative. Bed rest, analgesia, intravenous fluids, nasogastric decompression, enemas, cathartics, high-fibre diet, and stool softeners are the first line in management. Persistence of the symptoms or development of complications may warrant surgical treatment. The appropriate surgical approach depends on the nature of the interposed segment of the colon. Caecopexy may be adequate to eliminate the possibility of recurrence in an uncomplicated caecal volvulus, unless gangrene or perforation necessitates surgical resection. However, colonic resection is the best option for a volvulus of the transverse colon, and attempts at colonoscopic reduction are not recommended due to a high frequency of gangrene (16%) in this type of volvulus.6