ABSTRACT
Objective:To study the characteristics and related factors of neonatal intestinal necrosis caused by midgut volvulus.Methods:We retrospectively analyzed the clinical data of neonates with midgut volvulus who were admitted to Guangzhou Women and Children's Medical Center, from January 2009 to December 2019 and confirmed by surgery. The cases with intestinal necrosis belong to the intestinal necrosis group, and those without intestinal necrosis, the non-intestinal necrosis group which was randomly sampled at a ratio of about 4∶1 to the number of cases in the intestinal necrosis group. The two groups were compared in terms of personal history, age of onset, initial symptoms, vital signs within 2 h after admission, time from symptom onset to operation, clinical outcome, laboratory indicators within 2 h after admission, etc. Multivariate Logistic regression analysis was used to screen the related factors of intestinal necrosis in midgut volvulus. The effective warning indexes are screened by receiver operating characteristic (ROC) curve.Results:(1) Among 231 cases of midgut volvulus, 21 cases (9.1%, 21/231) had intestinal necrosis at the time of operation, 87 cases were included in the non-intestinal necrosis group. (2) The levels of heart rate within 2 h after admission, mean arterial pressure, WBC, C reactive protein (CRP), blood glucose and potassium in intestinal necrosis group were significantly higher than those in non-intestinal necrosis group ( P<0.05). Admission days of age, hemoglobin, serum albumin, serum sodium, pH and BE levels were significantly lower than those in the group without intestinal necrosis ( P<0.05). (3) In the multivariate analysis, increased heart rate, mean arterial pressure, serum CRP, and decreased serum sodium, serum albumin, and pH levels were predictors related to intestinal necrosis in patients with midgut volvulus. (4) The area under the ROC curve (AUC) of CRP was 0.883, the cutoff value was 9.88 mg/L, the sensitivity was 76.2%, and the specificity was 94.3%. The ROC curve of serum albumin was 0.792, the cut-off value was 36.65 g/L, the sensitivity was 70.1%, and the specificity was 94.3%. Conclusions:Heart rate, mean arterial pressure, increased CRP, decreased serum sodium, serum albumin and pH are helpful to predict whether intestinal necrosis occurs in midgut volvulus, and CRP > 9.88 mg/L and serum albumin < 36.65 g/L are likely warning indicators.
ABSTRACT
Introduction: Adult intussusception is a rare clinical entity in contrast to pediatric intussusception. Varied and non-specific clinical features, delayed presentation, and lack of awareness among attending surgeons to consider it as differential diagnosis complicates the clinical course of the disease. Methods: A retrospective study was conducted in a tertiary care teaching hospital in north India. Nine adult patients who presented with intussusception over a period of six years were analyzed. Their clinical profile, management and underlying pathology were studied. Results: Five out of nine patients had acute presentation while remaining four presented with subacute/chronic symptoms. Median duration of presentation was 8 days (range 2-180 days). Clinical diagnosis of intussusception was considered in only one patient. Ultrasonography clinched the diagnosis in all four patients who presented with subacute/chronic symptoms. Ileo-ileal intussusception was present in five patients, with one having associated jejunojejunal intussusception. Other four patients had ileo-colic intussusception. Seven of the 9 patients (77%) were found to have associated bowel gangrene. Resection of the bowel segment having intussusception was done in all patients. Five patients had associated benign intestinal pathology while idiopathic intussusception was present in four patients. Conclusion: The patients presented in the series are distinct from cases reported earlier in literature in term of late presentation, manifesting as acute intestinal obstruction, high frequency of associated intestinal gangrene, and absence of associated intestinal malignancy. Patients presenting with features of intestinal obstruction and abdominal lump should be subjected to urgent imaging studies to examine the possibility of intussusception. The high frequency of bowel gangrene encountered in patients of adult intussusception mandates prompt surgical intervention soon after diagnosis.