ABSTRACT
@#Sigmoid volvulus is rare in the pediatric population, generally occurring in the adult age group. This is a case report of sigmoid volvulus in a pediatric patient, documenting the clinical presentation, diagnostics, endoscopic and surgical management and outcome in a16 year old male presenting with crampy abdominal pain and difficulty in bowel movement. Abdominal x-ray revealed a dilated sigmoid colon in an inverted-U configuration. Emergency endoscopic detorsion was done with subsequent elective sigmoidectomy. Although sigmoid volvulus may be rare in the pediatric population, the diagnosis should always be considered in patients presenting with abdominal pain, obstruction and abdominal distension.
Subject(s)
Adolescent , ConstipationABSTRACT
OBJECTIVE: To explore the curative effects of the combined therapy of laparoscopic partial sigmoidectomy and anterior and posterior vaginal wall repair for the treatment of severe pelvic floor dysfunction(PFD).METHODS: The clinical data of 14 severe PDF patients(uterine prolapse in stage Ⅲ-Ⅳ）with dolichasigmoid were studied retrospectively from May 2017 to August 2018 in Shanghai Traditional Chinese Medical University. The surgical way was laparoscopic partial sigmoidectomy and anterior and posterior vaginal wall repair. The objective effects were assessed by comparing the position of each indication points of the preoperative and postoperative pelvic organs' prolapse(in POP-Q scale).Subjective effects were also assessed by comparing Clevel score of constipation,pelvic floor distress inventory-short form 20(PFDI-20),pelvic floor impact questionnaire short form(PFIQ-7)between preoperation and 6 months and 1 year after operation.RESULTS: All 14 patients were successfully operated on without any intra-operative and post-operative complications. The comparion of positions of the POP-Q indication points(AA,Ba,C,D,AP,BP)between preoperation and 1 year after operation showed the difference was statistically significant(P<0.01). PFDI-20,PFIQ-7 and Clevel constipation scores were also significantly different respectively(P<0.01).CONCLUSION: Laparoscopic partial sigmoidectomy combined with pelvic floor repair is an optional method in the treatment for pelvic floor dysfunction, which could effectively improve the constipation caused by dolichasigmoid and pelvic floor defect. It is also with low postoperative morbidity.
ABSTRACT
The endoscopic transluminal abdominal surgery by the natural orifices(NOTES)has nowadays some satisfactory results and initial success.In 2008,we successfully realized the first laparoscopic transluminal sigmoidectomy for a benign case in the world with a hybrid technique combining a single transombilical trocart and a transanal approach.For the NOTES,the major difficulty is to realize a perfect operative exposition and to reproduce the necessary triangulation for the surgical gestes.The application of intra-luminal ironic tube controlled by a puissant magnet and the devices with the articulable joints permits the satisfactory surgical exposition.During the first operation in human,we introduced transombilically the single trocart which with multiple operative canals of 18mm diameters,while the magnet devices both intra-luminally and externally maintaining the perfect exposition of the sigmoid.Finally,we pull out the dissected sigmoid by the transanal approach.The natural orifice approach benefits the reduce of numbers of trocarts and the cooperation with laparoscopic graspe gestes.It makes sometimes easier the laparoscopic procedures.We suggest the potential application of this technique in those benign cases and even small and early stage colonic cancer.[