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]
Bleeding, presenting as an intramural hematoma of the small intestine, is a rare complication, seen in 1 in 2,500 patients [ 2 ]. [omicsonline.org]
Entire Body System
- Pain
A 46-year-old woman presented to two emergency departments within 12 hours because of acute abdominal pain. Physical exam demonstrated tenderness and epigastric guarding. An ultrasound was interpreted as negative; she was discharged home. [experts.umn.edu]
After experiencing bloating and abdominal pain for several hours, he called an ambulance and underwent an emergency examination at our hospital. Abdominal distension, pressure pain, and rebound tenderness were observed throughout his entire abdomen. [ncbi.nlm.nih.gov]
Case Summary A 46-year-old African-American woman came to the emergency department because of acute lower abdominal pain of four-hours duration. She described the pain as sharp and severe. [hindawi.com]
Her recovery was uneventful, with full resolution of abdominal pain. [cmaj.ca]
- Severe Pain
Volvulus causes severe pain and progressive injury to the intestinal wall, with accumulation of gas and fluid in the portion of the bowel obstructed. [8] Ultimately, this can result in necrosis of the affected intestinal wall, acidosis, and death. [ipfs.io]
- Neonatal Intestinal Obstruction
[…] ileus NOS ( P76.0 ) neonatal 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 [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]
Gastrointestinal
- 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]
Diagnosis Patients with SBV may present with colicky abdominal pain, nausea, vomiting, abdominal distention, and obstipation [13]. [hindawi.com]
Among them, abdominal pain was the most common complaint (86%), followed by vomiting (80%). Severe continuous abdominal pain (53%) and circulatory disturbance (26%) are important symptoms that may predict strangulation. [hkjpaed.org]
The abdominal pain persisted and progressed in severity even after the administration of analgesic drugs. [nejm.org]
- Vomiting
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]
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]
Abdominal distention with bilious vomiting is observed within the first 24 hours after birth. [aafp.org]
Vomiting that happens soon after the baby starts to cry often means the blockage is in the small intestine; delayed vomiting usually means it's in the large intestine. The vomit may contain bile (which is yellow or green) or may resemble feces. [kidshealth.org]
Among them, abdominal pain was the most common complaint (86%), followed by vomiting (80%). Severe continuous abdominal pain (53%) and circulatory disturbance (26%) are important symptoms that may predict strangulation. [hkjpaed.org]
- 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]
September 28, 2004 171 (7) 728; DOI: https://doi.org/10.1503/cmaj.1040662 © 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 [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]
The following symptoms may be experienced with cecal volvulus: ballooning abdomen (abdominal distension) constipation diarrhea trouble passing gas severe abdominal pain vomiting Diagnosing cecal volvulus may be difficult because its symptoms mimic those [healthline.com]
As the sigmoid colon is located distally in the GI tract,vomiting is usually a late sign, whilst the colicky pain, abdominal distension, and absolute constipation occur earlier on in the clinical course. [teachmesurgery.com]
In the fifth postoperative month, she was admitted to the hospital with progressive abdominal distension and mild pain. [jmedicalcasereports.biomedcentral.com]
- Acute Abdomen
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]
Diagnosis is that of exclusion of the common causes of acute abdomen in the particular environment. [anmjournal.com]
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]
Midgut volvulus: a rare cause of acute abdomen in an adult patient. AJR Am J Roentgenol. 1998;171(3):639-41. Roggo A, Ottinger LW. Acute small bowel volvulus in adults. A sporadic form of strangulating intestinal obstruction. [sci-rep.com]
Cardiovascular
- 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]
Her past medical history was significant for hypertension and past surgical history included hysterectomy (for leiomyomas), unilateral oophorectomy, and appendectomy. [hindawi.com]
- Heart Disease
Down syndrome occurs in about one-quarter of these patients; congenital heart disease occurs in about 20 percent of them. [aafp.org]
Psychiatrical
- Suggestibility
Clinical clues suggesting presentations of small bowel volvulus are usually nonspecific; the diagnosis is typically confirmed at surgery. [experts.umn.edu]
This radiologic finding is known as the “whirl sign,” which occurs when bowel loops rotate around a fixed point of obstruction, suggesting intestinal volvulus. [nejm.org]
As findings suggestive of ischemia were observed in part of the intestines, emergency surgery was performed on the day of admission. Open surgery revealed approximately 500 mL of chylous ascites in the abdominal cavity. [ncbi.nlm.nih.gov]
Workup
Goals for treatment of small bowel volvulus should include physician awareness of this uncommon diagnosis, accurate workup, and advanced surgical intervention. [insights.ovid.com]
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]
Typically, when a patient requires opioid management, further workup is initiated to identify the underlying etiology. [hindawi.com]
X-Ray
- 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]
Laboratory
- Leukocytosis
Blood tests showed leukocytosis 21.8 x 10 9 /L and C-reactive protein 10 mg/L. Abdominal x-ray was normal, and abdominal ultrasonography revealed a small amount of anechogenic fluid between intestinal loops and in the hepatorenal recess. [acgcasereports.gi.org]
Worsening lactic acidemia and leukocytosis usually indicate worsening disease. D. Long-term management. The definitive management of volvulus is surgical correction. [cancertherapyadvisor.com]
The suspicion of vascular jeopardy must be borne in mind with associated features of fever, tachycardia, peritoneal signs, acidosis and leukocytosis. [ispub.com]
Treatment
The outlook for volvulus varies and depends largely on the speed of treatment. Early diagnosis and treatment of volvulus can help prevent serious complications. [medicalnewstoday.com]
Steven Rothenberg presents the laparoscopic treatment of malrotation and small bowel volvulus presenting the Ladd procedure. [websurg.com]
Laparoscopic treatment for volvulus has been described for all age groups. [ncbi.nlm.nih.gov]
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]
Recently neuroendocrine tumors are diagnosed increasingly and precociously improving the prognosis. [panafrican-med-journal.com]
Early diagnosis and immediate surgical intervention are key factors associated with a better prognosis for this group of patients. [pesquisa.bvsalud.org]
In general, bowel reconstruction is achieved by an end-to-end (or end-to-side) anastomosis (or anastomoses in multiple atresias). 15, 16 The prognosis is usually good unless excessive bowel resection is needed. [aafp.org]
Etiology
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]
The etiology, incidence, symptomatology and mortality are studied. [ncbi.nlm.nih.gov]
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]
Typically, when a patient requires opioid management, further workup is initiated to identify the underlying etiology. [hindawi.com]
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]
Rarely, appendicitis or surgery may lead to excessive adhesions leading to volvulus Epidemiology Colonic volvulus constituted nearly 2% of all the cases of bowel obstructions admitted in the United States between 2002-2010. [3] Sigmoid volvulus, accounting [ncbi.nlm.nih.gov]
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]
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. http://www.clinicalkey.com. Accessed Sept. 10, 2015. Glancy DG. Intestinal obstruction. [mayoclinic.org]
His surgical approach, now known as the Ladd procedure, remains the cornerstone of practice today. [5] Pathophysiology Intestinal malrotation occurs due to disruption of the normal embryologic development of the bowel. [emedicine.medscape.com]
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]
[…] dehydration and antibiotics to prevent infection. [luriechildrens.org]
Children may be started on IV (intravenous) fluids to prevent dehydration and antibiotics to prevent infection. [chop.edu]