A case report of small intestinal volvulus caused by lipomatosis of the small intestine successfully treated with enterectomy.

Small intestinal lipomatosis is a rare condition that presents a diagnostic challenge due to the absence of identifiable clinical symptoms and limitations of small intestine examination methods. Consequently, preoperative diagnosis is difficult and only a limited number of cases have been documented in the scientific literature. Here, we report a rare case of volvulus caused by small intestinal lipomatosis. A 58-year-old female patient was tentatively diagnosed with acute ileus. The whirl sign was detected using abdominal three-dimensional enhanced computed tomography, along with marked local intestinal dilation and multiple irregular fat-like containing lesions. During surgery, abnormal dilation of the small intestine between 80 and 220 cm from the ileocecal valve was detected and the affected intestine displayed a folded and twisted configuration. Examination of the resected intestine showed that the inner wall of the diseased intestinal lumen was covered with more than 100 lipomas of different sizes, the largest of which measured ~8.0 cm in diameter. Based on clinical symptoms alone, it was difficult to identify the cause of intestinal volvulus before surgery. Complete resection of the affected small intestine and subsequent pathological analysis yielded a definitive diagnosis of small intestinal lipomatosis. While small intestinal lipomatosis is a rare condition, prognosis is favorable if diagnosed early and treated appropriately. The application of three-dimensional enhanced computed tomography imaging can aid in accurate diagnosis, while complete resection of the affected small intestine is crucial to improve patient prognosis.

Multiplex attacks in sigmoid volvulus.

Objectives: Sigmoid volvulus (SV) recurs in about one quarter of the patients, whereas multiplex (≥3) attacks are quite rare and attacks with five or more times are extremely rare. The aim of this study was to evaluate multiplex SV attacks in our series and worldwide data. Methods: In Ataturk University Faculty of Medicine Department of General Surgery, among 1,071-case SV series, data were evaluated retrospectively in 612 patients, while prospectively in 459 with respect to age, gender, previous volvulus attacks, and prognosis. Worldwide data were obtained from Web of Science database and they were compared with our results. Results: Mean SV attack count, multiple- (≥2) and multiplex- (≥3) attack rates were 1.4, 26.1%, and 4.2%, respectively, in our series, while they were 1.7, 26.7%, and 3.2%, respectively, in worldwide data (p>0.05, in all). In our series, recurrence rates were 26.1%, 19.3%, and 51.2%, respectively, (p<0.001, in all), while mortality rates were 7.3%, 13.7%, and 19.5%, respectively, (p<0.001, in all) in single-, double-, and multiplex- (≥3) attack patients. Conclusion: Although multiplex (≥3) attacks are uncommon in SV, when it goes up, elective surgery must be considered in selected cases to avoid repetitive attacks and related high mortality.

Transverse Colon Volvulus Secondary to the Persistent Descending Mesocolon: A Case Report.

This case report introduces a rare occurrence of transverse colon volvulus associated with persistent descending mesocolon (PDM), a congenital anomaly characterized by the medial positioning of the descending colon due to a failed fusion with the dorsal abdominal wall. We detail the case of an 18-year-old female, with a medical history of surgically corrected coarctation of the aorta and anal atresia, who presented with recurrent transverse colon volvulus despite having undergone a laparoscopic colopexy three years earlier. Physical examination revealed abdominal distension and metallic colic sounds while imaging studies confirmed the recurrence of the volvulus. Laparoscopic partial resection of the transverse colon was performed, which revealed a medially positioned descending colon due to PDM. Postoperative complications included anastomotic failure, necessitating a second operation. The patient was successfully discharged without further complications after seven days. This case underscores the clinical significance of recognizing PDM, highlighting its potential role in causing transverse colon volvulus and increasing the risk of anastomotic failure. It emphasizes the need for surgeons to remain vigilant regarding this congenital anomaly to mitigate unexpected outcomes such as recurrent volvulus and postoperative complications.

Cecal volvulus - a rare cause of acute abdomen with ileus.

In this article, we present case reports of two patients admitted to the University Hospital in Pilsen for acute abdomen due to a disorder of the passage through the gastrointestinal tract (GIT). Both were indicated for surgery. The patients were diagnosed intraoperatively with rarely occurring cecal volvulus (CV). The findings required an ileocecal resection; nevertheless, both patients fully recovered despite the need the resection.

A Rare Case of Delayed Presentation of Acute Midgut Volvulus in an Adolescent.

Intestinal malrotation is primarily diagnosed in the neonatal period, when symptoms typically first appear. In contrast, occurrences in adults are quite uncommon. Adult cases are less frequently reported, often because the condition remains asymptomatic or presents with nonspecific symptoms that can delay diagnosis. Intestinal malrotation in adults can show a range of symptoms, from acute bowel obstruction to vague and chronic symptoms, often leading to a delay in the diagnosis compared to children. Patients with this condition present a distinctive challenge for surgeons regarding diagnosis and treatment, especially in acute situations. This study presents a rare case of a 16-year-old boy who came with chief complaints of acute abdominal pain and multiple episodes of bilious vomiting. The patient underwent an emergency laparoscopy converted to an open Ladd's procedure. During surgery, the duodenum, small intestine, cecum, and appendix were discovered to be abnormally positioned, and the transverse colon and mesentery were twisted along with the superior mesenteric artery and superior mesenteric vein, with the presence of classical Ladd's bands confirming preoperative CT findings of midgut volvulus. The patient tolerated the procedure well, with no intraoperative complications. Acute midgut volvulus is rare in adults and older children. Still, the differential diagnosis should be kept in mind in patients with pain in the abdomen and multiple episodes of bilious vomiting in cases with an uncertain diagnosis to plan proper management and avoid intraoperative surprises. Early detection, accurate imaging methods, and prompt intervention can mitigate complications that could increase morbidity and mortality.

Lipoblastoma-Related Volvulus in a Nine-Year-Old Female.

Lipoblastomas are benign neoplasms that arise from embryonal adipocytes. They predominantly impact the pediatric population, with most cases occurring in the first few years of life. These tumors typically present as a soft, palpable, painless mass and tend to involve the mesenchymal tissues of the extremities and trunk. Intraabdominal involvement and intraabdominal complications secondary to lipoblastoma are incredibly rare. Here, we present the case of a nine-year-old female who presented to the emergency department (ED) with one week of intermittent lower abdominal pain. The CT abdomen/pelvis demonstrated a well-circumscribed hypodense omental mass measuring 10.1 cm x 4.7 cm x 13.4 cm with minimal mass effect or bowel displacement. At that time, the patient's abdomen was soft without tenderness, distention, or rigidity. Her initial laboratory studies and vital signs were within normal limits. She was evaluated by pediatric surgery, who, given her clinical stability, planned for an anticipated elective resection. Thirteen days after her initial ED visit, the patient returned to the ED with nausea, vomiting, and diffuse abdominal pain. Repeat CT abdomen/pelvis revealed shifting of the omental mass from the left hemi-abdomen to the right hemi-abdomen with associated mesenteric 'swirl sign' and dilated loops of small bowel consistent with small bowel obstruction. Given the patient's CT findings and signs of peritonitis on a physical exam, she was emergently taken to the operating room, where the mass along with 20 cm of small bowel intimately associated with the mass was resected. The proximal end of the involved bowel was found to be twisted and necrotic, consistent with volvulus. A specimen was sent for cytogenetics and found to be positive for FLAG1, ultimately revealing a diagnosis of lipoblastoma. The majority of lipoblastoma development is underpinned by gene rearrangements in the zinc-finger transcription factor PLAG1. Although benign, these tumors can exhibit rapid proliferation and have high recurrence rates. Patients should be monitored long-term with ultrasound (US) or MRI following surgery to assess for recurrence.

Acute Primary Small Bowel Volvulus in a Male With Loeys-Dietz Syndrome.

Loeys-Dietz syndrome (LDS) is a connective tissue disorder with features including, but not limited to, aortic dissections, skeletal abnormalities, and craniofacial defects. However, considering its relatively recent discovery, there are still many unknowns about LDS. The extent of a connective tissue disorder like LDS is yet to be defined throughout the various organ systems, including the gastrointestinal system. Connective tissue disorders have been found to have higher associations with certain conditions, like constipation. In a similar manner, LDS may increase the propensity for developing uncommon gastrointestinal manifestations, like primary small bowel volvulus. A volvulus is defined as an abnormal rotation of the small bowel segment along the axis of its mesentery. Primary small bowel volvulus is differentiated from secondary small bowel volvulus by its nature of origin: primary small bowel volvulus occurs as an independent spontaneous occurrence, whereas secondary small bowel volvulus is secondary to the presence of adhesions, diverticular disease, or abdominal masses. In this case report, we highlight a potential gastrointestinal manifestation of LDS with the occurrence of a primary small bowel volvulus in a young adult male diagnosed with LDS. The patient experienced acute primary small bowel volvulus 14 days into his stay, which may have been influenced by this newfound connective tissue disorder.

Bochdalek's hernia in adults: A unique case with gastric volvulus and intrathoracic kidney.

INTRODUCTION AND IMPORATNCE: Introduction: Bochdalek's hernia (BH) is a congenital diaphragmatic hernia predominantly diagnosed in the pediatric population but infrequently found in adults. This paper presents a unique case of an adult patient with a left-sided BH accompanied by gastric volvulus and an intrathoracic kidney. CASE OF PRESENTATION: A 21-year-old male presented with abdominal pain and vomiting. An MDCT scan revealed a twisted stomach, spleen, and kidney herniated into the chest due to left diaphragmatic eventration. Surgery involved untwisting the stomach, relocating the organs, and removing the hernia sac. DISCUSSION: Bochdalek hernias (BHs) are rare conditions in which abdominal organs move into the chest due to defects in the diaphragm. BH usually occurs on the left side and can be triggered by factors such as pregnancy, obesity, or trauma. Symptoms can vary from abdominal pain to chest discomfort, and diagnosis can be challenging. Imaging tests such as CT scans are essential for accurate diagnosis. In adults, the BH can contain various organs, such as the spleen and kidney. Rarely, BH can be associated with an ectopic kidney located inside the chest cavity. In some cases of BH, there is a risk of complications such as gastric volvulus, where the stomach twists on itself, leading to potentially serious symptoms such as severe abdominal pain and vomiting. CONCLUSION: This case underscores the severe risks of BH in adults, such as gastric twisting and blockage, necessitating urgent surgery. Timely diagnosis and surgical intervention are crucial for preventing life-threatening outcomes. More research is needed to improve the management of this rare condition.

Gastric Tube Volvulus Occurring Years After Esophagectomy and Its Successful Treatment Via Endoscopic Stenting.

Esophageal cancer is frequently treated with esophagectomy, which is associated with distinct complications. Delayed gastric conduit emptying is a well-recognized complication that usually occurs within the postoperative period. By contrast, gastric tube volvulus is a rarer complication with a more variable time course of onset after esophagectomy and can be mistaken for delayed gastric conduit emptying. We describe the fifth reported case of gastric tube volvulus occurring years after esophagectomy and its successful treatment via endoscopic stenting.

Quadruple (1440 degrees) intestinal volvulus.

Key Clinical Message: A whirl sign on contrast-enhanced abdominal CT scan is indicative of intestine twisted around the mesenteric vessels, and is observed in cases of strangulated obstruction, signaling compromised intestinal circulation. In cases of intestinal volvulus, surgery is necessary to untwist the affected bowel, and resection is necessary if necrosis is present. Abstract: A 31-year-old Japanese man presented with acute lower abdominal pain and vomiting. Contrast-enhanced abdominal computed tomography (CT) revealed a 1440-degree clockwise torsion of superior mesenteric artery and a whirl sign. Intestinal volvulus in adulthood with a background of malrotation is extremely rare. Contrast-enhanced CT is effective for diagnosis.

Cecal bascule presenting as internal hernia.

Cecal bascule, a rare subtype of cecal volvulus, presents diagnostic and management challenges. We report a case of cecal bascule presenting as an internal hernia in a 68-year-old male with no surgical history. Computed tomography revealed two areas of mesenteric swirling and a displaced cecum. Prompt surgical intervention included laparoscopic exploration, resection of a necrotic adhesive band, and cecopexy. This case is noteworthy because of the absence of predisposing factors like prior surgeries or inflammatory conditions. Management options for cecal bascule include resection and cecopexy, tailored to individual patient factors. Awareness among healthcare providers is crucial for the timely recognition and appropriate management of such cases. Further research is needed to refine management strategies and improve outcomes for these rare but potentially life-threatening conditions.

Maternal Preeclampsia and a Preterm Neonate With Small Bowel Stenosis, Volvulus, and Severe Intrauterine Growth Restriction.

Preeclampsia is a human-specific hypertensive disorder of gestation. It is associated with short-term adverse effects in the fetus and long-term complications in the neonate, mainly due to disrupted blood flow during critical periods of intrauterine development. An ischemic event in the uterus can affect many systems of the fetus, including a small bowel involvement. We present a case of a preterm, small for gestational age neonate with severe intrauterine growth restriction, small bowel stenosis, and volvulus without malrotation, born to a mother with severe preeclampsia.

Two exploratory laparotomies within six days: A case of midgut volvulus in an adult with congenital malrotation.

INTRODUCTION: Midgut volvulus in adults based on congenital malrotation, which required emergency surgery, may occur under the stimulation of adverse factors and is rare and easy to be misdiagnosed. PRESENTATION OF CASE: A young male was taken to the emergency room of a local hospital after six hours abdominal pain. Computed tomography (CT) shows intestinal volvulus and exploratory laparotomy was performed. Postoperative CT revealed remission of small intestinal torsion and congenital malrotation of the midgut. The patient vomited frequently within 48 h after the surgery, and was transferred to our hospital for conservative treatment. After 4 days of conservative treatment, the vomiting symptoms were relieved at first, but worsened again after a liquid diet. CT showed complete duodenal obstruction and exploratory laparotomy was performed again. Congenital malrotation was found, which resulted in midgut volvulus and duodenal obstruction due to anomalous fixation of the mesentery. The bowel was placed in normal anatomical position, and the mesentery was sutured to the posterior abdominal wall. The patient was followed up for 24 months with no complaints. DISCUSSION: Due to the rare incidence and atypical pain clinical manifestations, it is difficult for the congenital malrotation in adults to be diagnosed. Midgut volvulus in adults with malrotation is even rarer and requires emergency operation, and may be misdiagnosed. CONCLUSION: Midgut volvulus with midgut malrotation is very rare in adults. Exploratory laparotomy must be careful to reduce misdiagnosis and recurrence of volvulus.

Sigmoid and cecum colon volvulus: a case report.

INTRODUCTION: Colon volvulus is the twisting of a segment of colon on its mesenteric axis, which can lead to the obstruction of the lumen and the blood supply. Colon volvulus is common in "volvulus belt" countries and can involve the sigmoid (60-70%) and cecum (25-40%). CASE PRESENTATION: We report a case of a 47-year-old male, Alawites, who presented with bowel obstruction and dilated abdomen without any specific abdominal pain. Abdominal laparotomy showed both sigmoid and cecum volvulus with no signs of perforation or ischemia. DISCUSSION AND CONCLUSION: One of the possible risk factors of sigmoid colon volvulus is the length of the rectum and sigmoid, while mobile cecum is considered as a possible reason for cecum volvulus. The management remains controversial and is specific for every case, depending mainly on the vitality of the colonic walls and the general condition of the patient.

Laparoscopic redo surgery for sigmoid volvulus following laparoscopic sigmoidectomy.

BACKGROUND: Sigmoid volvulus (SV) is an acute abdominal condition characterized by torsion of the sigmoid colon around the mesentery, and often results in intestinal obstruction that may progress to bowel ischemia, necrosis, or perforation. Although SV commonly occurs due to predisposing factors like anatomic variations, age-related motility disorders, chronic constipation, and neurologic diseases, its incidence following sigmoid colon cancer surgery has rarely been reported. Herein, we report a rare case of recurrent SV following laparoscopic sigmoidectomy, which was successfully treated by laparoscopic redo surgery. CASE PRESENTATION: The patient was a 77-year-old man who had previously undergone laparoscopic sigmoidectomy for sigmoid colon cancer. Sixteen months postoperatively, he developed an incisional hernia at the umbilical site, which was treated with a laparoscopic repair using an intraperitoneal onlay mesh. After the hernia surgery, the patient had no anastomotic leakage or stenosis on regular follow-ups. However, 65 months after the first surgery, he presented with abdominal pain and distension. A computed tomography revealed that the remnant sigmoid colon was distended in a twisting manner around the anastomosis, leading to the diagnosis of SV. Although endoscopic de-torsion was successful, the SV recurred 2 months later, requiring elective laparoscopic redo surgery. The procedure involved resection of the sigmoid colon including the prior anastomosis with a left pararectal incision and DST re-anastomosis using a 25-mm circular stapler. The operation lasted 165 min with minimal bleeding and no complications. The postoperative course was uneventful. Pathological analysis confirmed fibrosis without malignancy. The patient remains well without recurrence of SV and anastomotic stenosis more than 5 years after surgery. CONCLUSION: SV following sigmoid colon cancer surgery has rarely been reported. This case illustrates the potential need for prophylaxis against postoperative SV, especially in patients with long sigmoid colon undergoing laparoscopic surgery for colorectal cancer. Further, laparoscopic redo surgery following initial laparoscopic surgery for colorectal cancer can be performed with minimal invasiveness, especially if patient selection is properly managed.

Gallbladder volvulus misdiagnosed as acute acalculous cholecystitis: A case report.

INTRODUCTION AND IMPORTANCE: Gallbladder volvulus is a rare surgical disease with clinical manifestations similar to acute acalculous cholecystitis. Diagnosing gallbladder volvulus is critical as delayed surgical intervention in gallbladder volvulus is associated with high morbidity and mortality. CASE PRESENTATION: A 62-year-old male patient presented to our outpatient department for right upper quadrant pain of one-month duration. Taking into consideration the patient's clinical symptoms, laboratory results, and imaging findings, we diagnosed the patient with acute acalculous cholecystitis and started intravenous antibiotics. After 3 days, the clinical progress was unfavorable, laparoscopic cholecystectomy was performed, and the final diagnosis of gallbladder was done intraoperatively. The postoperative course was uneventful, and the patient was discharged on the second day after surgery. CLINICAL DISCUSSION: The cause of gallbladder volvulus may be related to abnormal embryological development, resulting in a long mesentery gallbladder and consequently leading to a floating gallbladder. Patients with gallbladder volvulus often do not exhibit specific signs, and the symptoms typically resemble those of acute acalculous cholecystitis. Once gallbladder volvulus is diagnosed, the surgical intervention must be conducted immediately. CONCLUSION: Gallbladder volvulus is a relatively rare and challenging condition to diagnose. It should be considered in cases of acute acalculous cholecystitis, especially in elderly, thin patients who do not respond to antibiotic treatment. Cholecystectomy is the definitive treatment for gallbladder volvulus. In particular, laparoscopic surgery should be chosen initially.

Volvulus is Stressful: Stress-Induced Cardiomyopathy Secondary to Gastric Volvulus and Paraesophageal Hernia.

Stress-induced cardiomyopathy (SCM) is a cardiac systolic dysfunction caused by various stressful triggers. It is often transient and reversible upon the reversal of the underlying stressor. We present the case of a 70-year-old female with SCM in the setting of gastric volvulus and incarcerated para-esophageal hernia.

Acute gastric volvulus complicated by gastric perforation following laparoscopic Nissen fundoplication; A case report.

INTRODUCTION: Laparoscopic Nissen Fundoplication is an effective standard surgical procedure for treatment of severe GERD. While it is generally safe and effective, a rare but potentially fatal complication known as acute gastric volvulus can occur following this procedure. CASE PRESENTATION: A 28-year-old male, ten months post Laparoscopic Nissen Fundoplication presented with a one-day history of severe epigastric pain, abdominal distention, unproductive retching, and difficulty in breathing. Examination revealed tachypnea, subcutaneous emphysema and a tender distended abdomen. Imaging studies showed a left pneumothorax, pneumoperitoneum, and a grossly distended stomach. Emergency exploratory laparotomy confirmed organoaxial gastric volvulus, necrosis of the greater curvature and gastric perforation. Partial gastrectomy and anterior gastropexy were performed. A left thoracostomy tube was placed to drain the left pneumothorax. He recovered fully post-operatively with complete resolution of all symptoms. DISCUSSION: Acute Gastric volvulus post Laparoscopic Nissen Fundoplication is attributed to adhesions, gastrostomy tubes, and foreign bodies like sutures. Life-threatening complications, such as gastric perforation, can ensue, underscoring the need for swift diagnosis and treatment. CONCLUSION: Acute gastric volvulus following Laparoscopic Nissen Fundoplication is a rare condition, and is difficult to diagnose. Given the steadily increasing rates of laparoscopic Nissen fundoplications performed in Uganda, maintaining a high index of suspicion is crucial for favorable patient outcomes among patients with this potentially fatal complication.

Gastric volvulus with necrosis and gangrene associated with wandering spleen: A rare case report from Syria.

Gastric volvulus and wandering spleen are two rare and uncommon conditions. Gastric volvulus is characterized by the rotation of the stomach around itself, causing a closed obstruction. It was first described in the 19th century and is classified according to the axis, etiology, or chronicity. A wandering spleen is defined by the absence of one or all of the splenic ligaments, which occurs either for congenital or acquired reasons. An enlarged spleen may contribute to the wandering spleen and, in turn, lead to gastric volvulus and infarction of the stomach, requiring emergency surgical intervention. In this report, we present a case of a 19-year-old female who presented to the emergency department with severe abdominal pain and epigastric distension. After performing the necessary investigations, she was diagnosed with a wandering spleen and acute gastric volvulus. An immediate laparotomy was performed and both the spleen and the stomach were resected to save the patient's life at the right time.