Caso infrecuente de oclusión intestinal por vólvulo de íleon / Infrequent case of intestinal occlusion due to ileum volvulus

Introducción: La oclusión intestinal mecánica es una enfermedad frecuente en los servicios quirúrgicos, sin embargo el vólvulo de intestino delgado es una de sus causas poco frecuentes. Objetivos: Describir las características clínicas de un caso de oclusión intestinal por vólvulo de íleon. Caso clínico: Paciente masculino de 63 años, con antecedentes de etilismo y pancreatitis crónica, para lo cual no llevaba tratamiento regular. Acudió al cuerpo de guardia por dolor abdominal de aproximadamente 24 horas de evolución. Presentó dos vómitos con restos alimentarios, sin fiebre u otros síntomas de interés. Semiotécnicamente el dolor era mantenido, difuso en todo el abdomen, intenso, punzante, no se aliviaba con analgésicos, sin otros síntomas acompañantes. Se realizaron estudios de laboratorio e imagenológicos, los resultados fueron sugerentes de un síndrome oclusivo y/o perforativo. Se decidió tratamiento quirúrgico, se diagnosticó una oclusión intestinal por vólvulo de íleon. Conclusiones: El diagnóstico del vólvulo de intestino delgado, requiere un alto índice de sospecha, debido a lo infrecuente en el adulto. Los hallazgos de imagen son de utilidad en el diagnóstico temprano. El tratamiento es eminentemente quirúrgico; se impone la resección intestinal del segmento afectado siempre que el tejido intestinal no sea viable(AU)

Introduction: Mechanical intestinal occlusion is a common disease in surgical services, however small bowel volvulus is one of its rare causes. Objectives: To describe the clinical characteristics of a case of intestinal occlusion due to ileum volvulus. Clinical case: A 63-year-old male patient, with a history of ethylism and chronic pancreatitis, for which he did not have regular treatment. He went to emergency due to abdominal pain of approximately 24 hours of evolution. He presented two vomits with food debris, without fever or other symptoms of interest. Semiotechnically the pain was maintained, diffuse throughout the abdomen, intense, stabbing, it was not relieved with analgesics. No other accompanying symptoms. Laboratory and imaging studies were performed, the results were suggestive of an occlusive and/or perforative syndrome. Surgical treatment was decided, an intestinal occlusion was diagnosed by ileum volvulus. Conclusions: The diagnosis of the small intestine volvulus requires a high index of suspicion, due to the infrequent occurrence in the adult. Image findings are useful in early diagnosis. The treatment is eminently surgical; Intestinal resection of the affected segment is imposed as long as the intestinal tissue is not viable(AU)

Malrotación intestinal en el adulto diagnosticado posterior a presentación del síndrome pospolipectomía en ciego: reporte de un caso / Intestinal malrotation in adults diagnosed after presentation of post polypectomy syndrome in the cecum: report of a case

RESUMEN La malrotación intestinal es una anomalía congénita de la rotación y fijación intestinal, diagnosticada de forma infrecuente en la edad adulta. Se presenta un caso de malrotación intestinal en un paciente adulto previamente asintomático con cambios en el hábito intestinal en los últimos 6 meses al que se le realiza una colonoscopia ambulatoria con la evidencia de un pólipo en el ciego, posterior a su resección presenta dolor abdominal agudo en fosa ilíaca izquierda que permite la realización de estudios imagenológicos que confirman el diagnóstico.

ABSTRACT Intestinal malrotation is a congenital anomaly of intestinal rotation and fixation, diagnosed infrequently in adulthood. We report the presence of intestinal malrotation in a previously asymptomatic adult patient with changes in bowel habit in the last 6 months after a colonoscopy is performed with evidence of a polyp in the cecum, after resection presenting acute abdominal pain in the left iliac fossa that allows imaging to confirm the diagnostic.

Neumatosis quística intestinal complicada con vólvulo intestinal / Pneumatosis cystoides intestinalis complicated with intestinal volvulus

La neumatosis quística intestinal es una condición infrecuente caracterizada por la presencia de quistes con gas en la subserosa o submucosa del tracto gastrointestinal. Su patogénesis es incierta y se han propuesto varios mecanismos patogénicos para explicar su origen. Se presenta el caso de un paciente de sexo masculino de 46 años de edad con diagnóstico previo de neumatosis quística intestinal, que consultó por dolor abdominal, vómitos y fiebre (39 °C). Ingreso con signos de irritación peritoneal. La radiografía simple de abdomen reportó distensión intestinal y niveles hidroaéreos. Se realizó laparotomía exploratoria que reveló vólvulo de intestino delgado con estrangulamiento de algunas asas intestinales. El diagnóstico anatomopatológico fue neumatosis quística intestinal complicada con Infarto transmural por vólvulo intestinal. El paciente evoluciono satisfactoriamente

Pneumatosis cystoides intestinalis is a rare condition in which multiple gas-filled cysts are found within the wall of the gastrointestinal tract either in the subserosa or submucosa. Its pathogenesis is uncertain and several pathogenic mechanisms have been proposed to explain its origin. The case of a male patient of 46 years with previous diagnosis of pneumatosis cystic intestinalis, who consulted for abdominal pain, vomiting and fever (39 °C) is presented. By the time of admission ther were signs of peritoneal irritation. The X-ray abdominal reported distension and intestinal hydro-air levels. Exploratory laparotomy was performed and revealed small bowel volvulus with strangulation of some intestinal segment. Histological diagnosis was pneumatosis cystic intestinalis complicated with Infarction trans-mural by intestinal volvulus. The patient evolved satisfactorily.

Pneumatosis intestinalis and volvulus: a rare association / Pneumatose intestinal e volvo: uma associação rara

Pneumatosis intestinalis (PI) is a rare condition, especially when associated with volvulus; it is often misdiagnosed and inappropriately treated. We present the case of a 27 year-old woman suffering from an acute abdomen. An abdominal tomography was performed revealing Pneumatosis intestinalis. Once in the operating theatre sigmoid volvulus was diagnosed and Hartmann surgery performed. Histology showed intestinal ischemia. During the hospital stay, evolution was favourable. The authors present this case and a brief theoretical review, due to its rarity and clinical interest.

A pneumatose intestinal (PI) é uma condição pouco frequente, sendo ainda mais rara em associação com volvo; sendo muitas vezes mal diagnosticada e tratada inapropriadamente. Apresentamos o caso de uma mulher de 27 anos com um quadro de abdómen agudo. Realizou TAC abdominal que demonstrou pneumatose intestinal. Intra-operatoriamente foi diagnosticado volvo da sigmoideia e optado por cirurgia de Hartmann. O resultado anatomo-patológico da peça foi compatível com isquémia intestinal. Durante o internamento hospital, a doente evoluiu favoravelmente. Os autores apresentam este caso e uma breve revisão teórica, pela sua raridade e interesse clínico.

Ileosigmoid Knot: A Rare Cause of Intestinal Obstruction.

Ileosigmoid knotting also known as compound volvulus or double volvulus is a rare cause of intestinal obstruction. Here, we present a case of acute intestinal obstruction in shock. The patient was resuscitated taken up for an emergency exploratory laparotomy, which revealed a large volume of hemorrhagic fluid and dilated gangrenous loops of ileum and sigmoid. A loop of ileum had encircled the base of sigmoid to form a knot resulting in gangrene of both the ileum and the sigmoid colon. Resection of gangrenous ileum and sigmoid colon with ileo-ileal and colorectal anastomosis with a temporary diversion colostomy was done.

Mesenteric cystic lymphangioma complicated by intestinal volvulus: a case report

Intestinal volvulus is an abdominal pathology which can affect the pediatric age group and may lead to catastrophic intestinal loss. The most common cause is malrotation but other etiologies are also reported. We report a case of intestinal volvulus in which the initial cause was mesenteric cystic lymphangioma

Midgut Volvulus in a 70-year-old Man Due to Intestinal Nonrotation / 대한소화기학회지

Intestinal malrotation is a congenital disorder that results from the failure of normal bowel rotation and fixation during the 5th gestational week. The incidence of intestinal malrotation is <0.2%, but prompt diagnosis is important because this anomaly can cause midgut volvulus and lead to fatalities. Compared to infants presenting with acute symptoms, such as abdominal pain, vomiting, or diarrhea, adult patients complain of intermittent self-limited abdominal pain. We present a case of intestinal malrotation complicated by midgut volvulus improved with conservative care in a 70-year-old man. The diagnosis was suggested on the basis of imaging findings.

Post- infantile presentation of intestinal malrotation

To study intestinal malrotation presenting after the age of one year, analyze the spectrum of presentations and to predict risk of volvulus. Retrospective study. Zagazig University Hospitals [Egypt] and King Fahd Hospital, Saudi Arabia. All cases [54] of malrotation during April 2006 to April 2010. Analysis of clinical, radiological and operative data. Presentation, significant associations and risk of volvulus. The mean age was 4.8 +/- 2.13 years. Presentations included acute volvulus [n = 27, 50%], chronic volvulus [4, 7.5%], mesocolic hernia [4, 7.5%], intussusception [5, 9%], exomphalos [5, 9%] and non-specific presentation [9, 17%]. Associated anomalies were found in 19 cases [35%] with significant association of chronic volvulus and exomphalos. Typical anatomical malrotation was seen in 21 [39%] cases with significant risk of volvulus [odds ratio 9.2]. Nausea and vomiting, abdominal colic, and malnutrition were dominant in acute and chronic volvulus, mesocolic hernia and intussusception [p < 0.05]. Malnutrition and gastroesophageal reflux disease [GERD] were significantly associated with chronic volvulus [p < 0.05]. Duodenal obstruction was significantly evident in acute volvulus while high cecum was dominant in intussusception. Prolonged ileus and persistent symptoms were significant in chronic volvulus and mesocolic hernia [p < 0.05], while wound infection and short bowel syndrome were significant in acute volvulus. Malrotation in the post-infantile period has a wide spectrum and non-specific presentation. Risk of midgut volvulus is present, especially in typical cases, and trials must be done to predict the risk and avoid unnecessary surgery

El signo de la cáscara de manzana en vólvulo de intestino medio / The apple-peel syndrome in midgut volvulus

The apple-peel sign represents an image visualized on oral contrast-enhanced examination of the upper gastrointestinal tract in patients with midgut volvulus. Its recognition is vital for a timely diagnosis to prevent treatment delay, since this condition represents a true surgical emergency.

El signo de la cáscara de manzana corresponde a una imagen visualizada en el estudio con contraste oral del tubo digestivo alto en pacientes que presentan vólvulo del intestino medio. Su reconocimiento es fundamental para hacer el diagnostico de manera oportuna, sin retrasar el tratamiento, ya que se considera una emergencia quirúrgica.

Nonrotation of the Prearterial Segment of Midgut Presenting as Duodenal Obstruction in a 60-Year-Old Man / 대한소화기학회지

Intestinal malrotation is a developmental anomaly resulting from embryologic failure of fixation and rotation of the gut and predisposed to midgut vovulus and small bowel obstruction. Although various forms of malrotation anomalies in the gut can occur, nonrotation of prearterial segment with the initial symptomatic presentation at advanced age has been rarely reported. Here, we report a case of nonrotation of the prearterial segment of the midgut presenting with duodenal obstruction in a 60-year-old man. To our best knowledge, this is the first case reported about nonrotation of prearterial segment of the midgut in Korea.

Sigmoid volvulus complicating pregnancy managed by resection and primary anastomosis: case report with literature review

Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pregnancy. The rarity of the condition and the fact that pregnancy itself clouds the clinical picture invariably leads to a delay in diagnosis with an increased risk of gangrene of the gut. The majority of these patients would then require resection and colostomy. However, an early diagnosis and intervention as in our patient, which would require a high index of clinical suspicion, could significantly improve the outcome of the foetus and the mother. A case of sigmoid volvulus in pregnancy is reported which was managed by resection and primary anastomosis. A review of literature revealed no previous reports of sigmoid volvulus in pregnancy managed by primary anastomosis following resection of the sigmoid volvulus. The literature is also reviewed regarding predisposing factors, management options and the outcome of sigmoid volvulus complicating pregnancy

Small Bowel Volvulus Induced by Mesenteric Lymphangioma in an Adult: a Case Report

Mesenteric lymphangiomas are rare abdominal masses that are seldom associated with small bowel volvulus, and especially in adult patients. We report here on an unusual case of small bowel volvulus that was induced by a mesenteric lymphangioma in a 43-year-old man who suffered from repeated bouts of abdominal pain. At multidetector CT, we noticed whirling of the cystic mesenteric mass and the adjacent small bowel around the superior mesenteric artery. Small bowel volvulus induced by the rotation of the mesenteric lymphangioma was found on exploratory laparotomy. Lymphangioma should be considered as a rare cause of small bowel volvulus in adult patients.

Midgut malrotation in older children

Midgut malrotation is typically presented during the first few months of life but sometimes may encounter later in life, causing difficulties and mistakes in diagnosis. We reviewed records of eleven rare patients with midgut malrotation older than one year of age and extracted their clinical and paraclinical data. The most common presenting symptoms were bilious vomiting, recurrent abdominal pain and constipation. Five of eleven patients had presented from neonatal period. The average interval between first symptoms and surgical correction of malrotation was about 22 months. Some of the patients had been undergone false treatments. Most cases were diagnosed by contrast studies [upper gastrointestinal series and barium enema]. Diagnosing midgut malrotation in older children is often delayed. This anomaly should be suspected in all children with signs and symptoms of small bowel obstruction, chronic abdominal pain and vague abdominal discomfort and in all patients of any age with abdominal discomfort who do not respond to other therapies. Contrast studies may be necessary to rule out malrotation in suspected patients

Surgical management of colonic volvulus during same hospital admission

To study the local patient profile, diagnostic methods, and treatment outcome in patients with large bowel volvulus to recommend a management plan. A retrospective study of patients record with a final diagnosis of large bowel volvulus treated at King Saud Medical Complex, Riyadh, Saudi Arabia between January 2000 and December 2007 were performed for patient demography, clinical presentations, co-morbidity, diagnostic methods, anatomical types, management, and outcome. Forty-two patients with large bowel volvulus were reviewed. They represented 8.5% of all intestinal obstructions treated. Most had sigmoid volvulus [83%], were less than 60 years of age, and were male. Recognized risk factors were present in 12 [29%] patients. Diagnosis was suspected on plain abdominal x-ray in 28 patients [69%], although the characteristic signs of omega and coffee bean were seen in only 16 patients. Eight patients required emergency surgery. Endoscopic decompression was successful in 34 patients, followed by a definitive surgery in 24 patients. Seven patients refused surgery; 3 of them were readmitted with recurrence and were operated. Three patients were unfit for surgery. There were 3 deaths. Large bowel volvulus is uncommon in this area. Abdominal distension with pain, constipation, and characteristic gas pattern in plain x-ray can help diagnose most cases. Decompression can be achieved in most patients with sigmoid volvulus, followed by surgery during the same hospital admission. Transverse colon and cecal volvulus usually need emergency surgery