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Volvulus of the Small Intestine

Intestine Small Volvulus


Presentation

  • This report describes a very rare case of right paraduodenal hernia presenting as volvulus of nonherniated small intestine.[ncbi.nlm.nih.gov]
  • Clinical clues suggesting presentations of small bowel volvulus are usually nonspecific; the diagnosis is typically confirmed at surgery.[experts.umn.edu]
Neonatal Intestinal Obstruction
  • intestinal obstructions classifiable to P76.- obstruction of duodenum ( K31.5 ) postprocedural intestinal obstruction ( K91.3- ) stenosis of anus or rectum ( K62.4 ) Paralytic ileus and intestinal obstruction without hernia Approximate Synonyms Duodenal[icd10data.com]
  • Shenoy MU, Singh SJ, Robson K, Stewart RJ: Gastrointestinal stromal tumor: a rare cause of neonatal intestinal obstruction. Med Pediatr Oncol 34:70-71, 2000 Google Scholar 12.[springerlink.com]
  • Duodenal atresia, midgut malrotation and volvulus, jejunoileal atresia, meconium ileus and necrotizing enterocolitis are the most common causes of neonatal intestinal obstruction.[aafp.org]
Ecchymosis
  • Many types of bleeding are commonly described as minor, such as ecchymosis, epistaxis, gingival bleeding, and hematuria. However, more serious bleeding can occur in certain organs such as the brain, the pericardium, the pleura, or the abdomen [ 1 ].[omicsonline.org]
Abdominal Pain
  • A 12-year-old boy presented with sudden onset of lower abdominal pain, and emergency laparotomy was performed on a diagnosis of small intestinal obstruction.[ncbi.nlm.nih.gov]
  • Important features of the presentation are the acute onset of the abdominal pain and its severity which is often inconsistent with the findings on clinical examination.[link.springer.com]
  • Observation: A 60-year-old patient was admitted to the emergency department with diffuse abdominal pain and anuria that had started several hours earlier.[omicsonline.org]
Vomiting
  • A 2 months-old girl presented with history of bilious vomiting, sonography showed signs of volvulus and emergency laparotomy was performed and confirmed left paraduodenal hernia containing a part of the ileon, coecum with right colon and volvulus of the[ncbi.nlm.nih.gov]
  • Her unremitting abdominal pain, persistent vomiting, and absolute neutrophilia were consistent with an acute process. The etiology of this volvulus was caused by an elastic fibrous band at the root of the jejunal mesentery.[experts.umn.edu]
  • The symptoms of abdominal pain, distention and vomiting are nonspecific and common to other causes of upper intestinal obstruction.[anmjournal.com]
  • Abdominal distention with bilious vomiting is observed within the first 24 hours after birth.[aafp.org]
  • Bilious vomiting is the key presenting symptom. A child presenting with green or yellow vomiting should be presumed to have volvulus until proved otherwise.[patient.info]
Nausea
  • The condition is characterized by lack of bowel sounds, nausea, vomiting, painful sensations, and a taut and swollen abdomen.[medical-dictionary.thefreedictionary.com]
  • The symptoms and signs of a volvulus may include abdominal pain , nausea, vomiting, and blood in the stool. The treatment is surgery to free the obstruction and ensure normal blood flow to the bowel. Volvulus is a surgical emergency.[medicinenet.com]
  • Synopsis C CMAJ September 28, 2004 171 (7) 728; DOI: 2004 Canadian Medical Association or its licensors A 61-year-old woman presented to the emergency department with acute abdominal pain of several hours' duration accompanied by nausea but no vomiting[cmaj.ca]
  • Symptoms may include abdominal cramping bloody stools constipation nausea signs of shock vomiting People with any of these symptoms should be evaluated immediately by a health care provider.[colorectal.surgery.ucsf.edu]
Abdominal Distension
  • A 56-year-old woman, with a history of appendectomy 30 years previously, was admitted with abdominal distension and signs of peritonitis.[ncbi.nlm.nih.gov]
  • Constipation may worsen, and abdominal distension can increase. Death is possible if the condition progresses. In fact, researchers report a mortality rate of up to . Cecal volvulus is relatively rare, according to .[healthline.com]
  • In the fifth postoperative month, she was admitted to the hospital with progressive abdominal distension and mild pain.[jmedicalcasereports.biomedcentral.com]
  • Abdominal examination revealed moderate abdominal distension, with significant diffuse pain, without acute peritoneal findings. The general physical examination was normal.[scielo.br]
Acute Abdomen
  • Diagnosis is that of exclusion of the common causes of acute abdomen in the particular environment.[anmjournal.com]
  • Clinical presentation can vary from mild, vague abdominal pain to intestinal obstruction and an acute abdomen [ 6 , 7 ]. Our patient displayed an acute abdomen with widespread abdominal defense.[omicsonline.org]
  • So physician should consider it as one of the causes of acute abdomen. Categories Clinical,Gastroenterology and Hepatology[hkjpaed.org]
  • Clinical case A 30 year-old male with sarcoidosis presents with acute abdomen and clinical data of intestinal obstruction.[elsevier.es]
Hypertension
  • The patient had a history of hypertension for which he was receiving oral treatment. Abdominal contrast-enhanced computed tomography (CT) revealed an edematous change in the intestinal membrane and volvulus of the small intestine.[ncbi.nlm.nih.gov]
  • Co-morbidities such as hypertension [ 8 - 11 ], atrial fibrillation [ 10 ], and renal failure [ 9 ] also appear to be risk factors for hemorrhagic complications.[omicsonline.org]
Strabismus
  • More specifically, this 15-year-old girl has a history of strabismus repair in 2011 and right foot surgery for an arteriovenous angiodysplasia lesion. Angiodysplasia was diagnosed after an episode of abdominal pain and a rectorrhagia in 2010.[websurg.com]
Epistaxis
  • Many types of bleeding are commonly described as minor, such as ecchymosis, epistaxis, gingival bleeding, and hematuria. However, more serious bleeding can occur in certain organs such as the brain, the pericardium, the pleura, or the abdomen [ 1 ].[omicsonline.org]
Anuria
  • Observation: A 60-year-old patient was admitted to the emergency department with diffuse abdominal pain and anuria that had started several hours earlier.[omicsonline.org]
Neglect
  • Maetani S, Tobe T, Kashiwara S (1984) Neglected role of torsion and constriction in pathogenesis of simple adhesive bowel obstruction. Br J Surg 71:127–130 CrossRef PubMed 11. Khurana B (2003) The whirl sign. Radiology 226:69–70 CrossRef PubMed 12.[springermedizin.de]

Workup

  • Delay in diagnosis and therefore surgical intervention results in high morbidity and mortality which calls for surgeon awareness, accurate workup of the patient, and prompt surgical intervention.[anmjournal.com]
  • Goals for treatment of small bowel volvulus should include physician awareness of this uncommon diagnosis, accurate workup, and advanced surgical intervention.[insights.ovid.com]
Bowel Distention
  • After a few hours of postnatal life, bowel distention becomes remarkable because of swallowed air and causes bilious vomiting. In some cases, meconium retention may cause dystociaproducing abdominal distention.[aafp.org]
X-Ray Abnormal
  • Ten patients (28.6%) showed X-rays abnormalities (excluding isolated diverticula), wide-mouthed sacculations being the most frequent finding. Our data confirm that the colon is frequently involved in SS, even in the limited form of the disease.[link.springer.com]

Treatment

  • The patient had a history of hypertension for which he was receiving oral treatment. Abdominal contrast-enhanced computed tomography (CT) revealed an edematous change in the intestinal membrane and volvulus of the small intestine.[ncbi.nlm.nih.gov]
  • Resection and primary anastomosis of the involved segment is the treatment of choice with a good prognosis.[anmjournal.com]
  • Clinical treatment should be instituted in the absolute majority of cases.[omicsonline.org]
  • This should be considered since these patients reguire early diagnosis and treatment. Our case may be even rarel because it occurred after sexual intercourse.[jstage.jst.go.jp]
  • Steven Rothenberg presents the laparoscopic treatment of malrotation and small bowel volvulus presenting the Ladd procedure.[websurg.com]

Prognosis

  • Reference is made to the literature of massive resection of the small intestine to illustrate that the prognosis is not necessarily poor when resections are extensive.[ncbi.nlm.nih.gov]
  • Resection and primary anastomosis of the involved segment is the treatment of choice with a good prognosis.[anmjournal.com]
  • Recently neuroendocrine tumors are diagnosed increasingly and precociously improving the prognosis.[panafrican-med-journal.com]
  • If necrosis of the bowel occurs the prognosis is often poor, depending on how much of the bowel is necrotic.[iffgd.org]

Etiology

  • The etiology, incidence, symptomatology and mortality are studied.[ncbi.nlm.nih.gov]
  • The etiology of this volvulus was caused by an elastic fibrous band at the root of the jejunal mesentery. While congenital fibrous bands are rare in adults, this interpretation is favored for two reasons.[experts.umn.edu]
  • Such cultures originate in parts of Africa and the Middle East. 1 , 3 Certain anatomic variations have been proposed as etiologic factors for SBV.[jaoa.org]

Epidemiology

  • Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry. Arch Surg Chic Ill 1960. Mars 2007; 142(3):229-35.[panafrican-med-journal.com]
  • Epidemiology Malrotation Malrotation occurs in approximately 1 in 500 live births. However, the true incidence of malrotation is unknown, since many asymptomatic patients fail to present. Either sex can be affected with the anomaly.[patient.info]
  • Epidemiology Frequency United States Intestinal malrotation occurs in between 1 in 200 and 1 in 500 live births. [6, 7] However, most patients with malrotation are asymptomatic, with symptomatic malrotation occurring in only 1 in 6000 live births. [8][emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • CT showed two specific findings, split-bowel sign and rotating-C sign, which we think reflect pathophysiologic features of organo-axial volvulus.[ncbi.nlm.nih.gov]
  • Obstruction of the intestinal lumen can cause pathology due to stretching of the bowel proximal to the lesion - see Pathophysiology of Ileal impaction Ileum: impaction .[vetstream.com]
  • In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. . Accessed Sept. 10, 2015. Glancy DG. Intestinal obstruction. Surgery. 2014;34:204.[mayoclinic.org]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features (9 ed.). Elsevier Health Sciences. p. 384. ISBN 1437727670.[ipfs.io]

Prevention

  • Volvulus of the small intestine must be considered when a patient presents with small-bowel obstruction, and early operative intervention should be undertaken to prevent vascular compromise.[ncbi.nlm.nih.gov]
  • Volvulus of the small intestine must be considered when a patient presents with small-bowel obstruction, and early operative intervention should be undertaken to prevent vascular compromise. Lippincott-Raven Publishers.[journals.lww.com]
  • […] dehydration and antibiotics to prevent infection.[luriechildrens.org]

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