Vólvulo cecal: reporte de un caso / Cecal volvulus: a case report

El vólvulo cecal es una causa rara de abdomen oclusivo agudo. Cada año, aproximadamente 2,8-7,1 personas por millón se ven afectadas por esta patología. Se estima que el vólvulo cecal representa el 25-40% de todo el vólvulo del colon. Causa alrededor del 1-1,5% de las oclusiones intestinales en adultos. La mayoría de los pacientes presentan síntomas de hinchazón, estreñimiento, náuseas y vómitos. Hasta el 50% puede tener síntomas intermitentes antes de la torsión. Su baja prevalencia dificulta su diagnóstico preoperatorio, siendo diagnosticado frecuentemente durante la cirugía. Presentamos el caso de un hombre de 66 años que ingresa por dolor abdominal, cuyos métodos de imagen complementarios iniciales fueron diagnósticos de abdomen agudo oclusivo y finalmente durante la cirugía se observó un vólvulo cecal

The cecal volvulus is a rare cause of an acute occlusive abdomen. Each year, approximately 2.8-7.1 people per million are affected by this pathology. It is estimated that the cecal volvulus represents 25-40% of all the colon volvulus. Causing about 1-1.5% of intestinal occlusions in adults. Most patients have symptoms of bloating, constipation, nausea, and vomiting. Up to 50% may have intermittent symptoms before torsion. Its low prevalence hinders its preoperative diagnosis, being frequently diagnosed during surgery. We present a case of a 66-year-old man admitted for abdominal pain, whose initial complementary imaging methods were diagnostic of acute occlusive abdomen and finally a cecal volvulus was observed during surgery

Factors precipitating volvulus formation in sigmoid volvulus.

BACKGROUND: Sigmoid volvulus (SV), the wrapping of the sigmoid colon around itself, is a rare intestinal obstruction form world-wide. For this reason, the physiopathology of SV, particularly the precipitating factors, are not clearly identified. The aim of this study is to evaluate the precipitating factors in SV. METHODS: The clinical records of consecutive 416 patients with SV were reviewed prospectively from January 1986 to July 2020. As a control, the records of consecutive 100 patients with non-volvulus intestinal obstruction were reviewed prospectively in the past 24 months. The premorbid symptoms including acute diarrhea, sudden and excessive body motions, overeating after a prolonged starvation, coughing spell, and labor was evaluated. RESULTS: Among the premorbid symptoms, 1-5-day interval of diarrhea (42 patients, 10.1%, p<0.05), harvesting activation (35 patients, 8.4%, p<0.05), and overeating after Ramadan fasting (31 patients, 7.5%, p<0.05) were found to be statistically significant precipitating factors in SV. CONCLUSION: Although there are few studies about the precipitating factors of SV in the literature, increased bowel motility, excessive body motions, and overeating following a prolonged starvation look like the precipitating factors in the development of SV.

Diseases of the digestive system of agoutis (Dasyprocta leporina) raised in captivity in the Brazilian semiarid region / Doenças do sistema digestivo de cutias (Dasyprocta leporina) criadas em cativeiro na região semiárida brasileira

The objective of this study was to describe the clinical and pathological aspects of diseases of the digestive system in agoutis (Dasyprocta leporina Linnaeus, 1758) diagnosed by the "Laboratório de Patologia Veterinária" (Veterinary Pathology Laboratory) of the "Universidade Federal Rural do Semi-Árido" (UFERSA), from January 2018 to February 2020. During the study period, necropsy and a survey of the clinical history of 27 agoutis were performed, 25.93% (7/27) of which were diagnosed with digestive system diseases. The percentages of digestive tract diseases among the diagnosed were: acute carbohydrate overload (11.12%), gastric ulcer (7.41%), gastric volvulus (3.70%), and intestinal volvulus (3.70%). Studies on the occurrence rate of these diseases, as well as the description of their clinical and anatomopathological aspects, may serve as a basis for guiding the appropriate management in the breeding of these animals.(AU)

O objetivo deste estudo foi descrever os aspectos clínicos e patológicos das doenças do aparelho digestivo em cutias (Dasyprocta leporina Linnaeus, 1758) diagnosticadas pelo Laboratório de Patologia Veterinária da Universidade Federal Rural do Semiárido (UFERSA), de janeiro 2018 a fevereiro de 2020. Durante o período do estudo, foram realizadas necropsias e levantamento da história clínica de 27 cutias, sendo 25,93% (7/27) diagnosticadas com doenças do aparelho digestivo. Os percentuais de doenças do aparelho digestivo foram: sobrecarga aguda de carboidratos (11,12%), úlcera gástrica (7,41%), vólvulo gástrico (3,70%) e vólvulo intestinal (3,70%). Estudos sobre a taxa de ocorrência dessas doenças, bem como a descrição de seus aspectos clínicos e anatomopatológicos, podem servir de base para orientar o manejo adequado na criação dessa espécie.(AU)

Diseases of the digestive system of agoutis (Dasyprocta leporina) raised in captivity in the Brazilian semiarid region / Doenças do sistema digestivo de cutias (Dasyprocta leporina) criadas em cativeiro na região semiárida brasileira

The objective of this study was to describe the clinical and pathological aspects of diseases of the digestive system in agoutis (Dasyprocta leporina Linnaeus, 1758) diagnosed by the "Laboratório de Patologia Veterinária" (Veterinary Pathology Laboratory) of the "Universidade Federal Rural do Semi-Árido" (UFERSA), from January 2018 to February 2020. During the study period, necropsy and a survey of the clinical history of 27 agoutis were performed, 25.93% (7/27) of which were diagnosed with digestive system diseases. The percentages of digestive tract diseases among the diagnosed were: acute carbohydrate overload (11.12%), gastric ulcer (7.41%), gastric volvulus (3.70%), and intestinal volvulus (3.70%). Studies on the occurrence rate of these diseases, as well as the description of their clinical and anatomopathological aspects, may serve as a basis for guiding the appropriate management in the breeding of these animals.

O objetivo deste estudo foi descrever os aspectos clínicos e patológicos das doenças do aparelho digestivo em cutias (Dasyprocta leporina Linnaeus, 1758) diagnosticadas pelo Laboratório de Patologia Veterinária da Universidade Federal Rural do Semiárido (UFERSA), de janeiro 2018 a fevereiro de 2020. Durante o período do estudo, foram realizadas necropsias e levantamento da história clínica de 27 cutias, sendo 25,93% (7/27) diagnosticadas com doenças do aparelho digestivo. Os percentuais de doenças do aparelho digestivo foram: sobrecarga aguda de carboidratos (11,12%), úlcera gástrica (7,41%), vólvulo gástrico (3,70%) e vólvulo intestinal (3,70%). Estudos sobre a taxa de ocorrência dessas doenças, bem como a descrição de seus aspectos clínicos e anatomopatológicos, podem servir de base para orientar o manejo adequado na criação dessa espécie.

Colostomía endoscópica percutánea como tratamiento de un vólvulo de sigma recidivante en paciente casi centenario / No disponible

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Fulminant gastrointestinal ischemia due to yeyunal volvulus

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Colonic obstruction in a tetraplegic patient: a common symptom from an uncommon cause.

INTRODUCTION: It is difficult to diagnose an acute abdomen condition in people with spinal cord injury due to abnormal sensation below the injured level and multiple co-morbidities. These issues can mislead the exact diagnosis and delay proper treatment. CASE PRESENTATION: A 57-year-old male with C4 AIS C tetraplegia developed nausea and vomiting, abdominal distension and feeding intolerance. Serum electrolytes indicated severe hyponatremia. A provisional diagnosis of pseudo-gut obstruction was made. After the failure of 48 h of conservative treatment with a nasogastric and rectal tube, abdominal CT was performed and revealed sigmoid volvulus. CONCLUSIONS: Due to the inconclusive clinical features and lack of subjective complaints, early use of CT scan or MRI is preferable in people with SCI who are suspected of an emergency intra-abdominal condition.

CT findings in five dogs with surgically confirmed colonic torsion.

Colonic torsion is a life-threatening condition that results in colonic ischemia, necrosis, perforation, sepsis, and eventual death. The aim of this multicenter, retrospective case series study was to describe the CT findings in dogs with surgically confirmed colonic torsion. Medical records were searched for dogs with surgically confirmed colonic torsion following abdominal CT. Five dogs met the inclusion criteria. Three had a history of chronic intermittent diarrhea prior to presentation. Two dogs presented with acute vomiting, diarrhea, and abdominal pain and one dog presented with acute vomiting and lethargy. Computed tomographic findings in all dogs with surgically confirmed colonic torsion include: "whirl sign," displacement and distension of the cecum and colon, focal narrowing of the colon, and distension of the mesenteric vasculature in all dogs (5/5); streaky peritoneal fat and peritoneal effusion (4/5), pneumatosis coli (2/5), small intestinal distension (2/5), portal vein thrombosis (1/5), and reduced colonic wall contrast enhancement (1/5). In all dogs (5/5), the torsion site was the descending colon and demonstrated an anticlockwise rotation. At surgery, three of the five dogs had a partial colonic torsion with hyperemia at the site of obstruction and two of the five dogs had a complete torsion with marked necrosis of the colonic wall. Displacement of the colon and cecum, segmental distension and focal narrowing of the colon, the presence of a "whirl sign" and distension of the mesenteric vasculature are CT findings highly suggestive of colonic torsion.

Use of ultrasound findings to predict bowel ischemic changes in pediatric patients with intestinal volvulus.

OBJECTIVES: Early diagnosis and prompt surgical intervention are important to prevent intestinal necrosis in patients with volvulus. The purpose of this study was to determine which ultrasound (US) findings may predict bowel ischemic changes in pediatric patients with intestinal volvulus. METHODS: Thirty-one pediatric patients with surgically proven intestinal volvulus were retrospectively reviewed. We compared the demographics and US findings (eg, superior mesenteric artery collapse, ascites, echogenic ascites, and degree of intestinal twist) between patients with and without bowel ischemic changes during surgery. Data are presented as median and range. The Fisher exact test, Mann-Whitney U test, and Wilcoxon signed rank sum test were used for statistical analyses. RESULTS: Eleven patients had bowel ischemic changes. Significant differences existed between patients with and without ischemic changes for age (2 days [range, 0-137 days] versus 6.5 days [range, 2-1618 days]; P = .02), superior mesenteric artery collapse (present/absent, 10/1 versus 9/11 patients; P = .02), the presence of ascites (present/absent, 8/3 versus 6/14 patients; P = .03), and intestinal twist degree on US imaging (540° [range, 180°-720°] versus 360° [range, 180°-720°]; P = .02). The groups did not significantly differ for sex, the time from the US examination to the operation, or echogenic ascites. The intestinal twist degree insignificantly differed between US and surgical findings (360° [range, 180°-720°] versus 360° [range, 0°-1080°]; P = .36). CONCLUSIONS: The presence of superior mesenteric artery collapse, ascites, and a large intestinal twist on US imaging were significant predictors of intestinal ischemic changes. Pediatric surgeons should perform prompt surgical interventions in cases of volvulus with these US findings.

[Total small bowel volvulus complicating common incomplete mesentery, an exceptional complication in adults: about a case]. / Volvulus total du grêle sur mésentère commun incomplet, une complication exceptionnelle chez l'adulte: à propos d'un cas.

Total small bowel volvulus complicating common incomplete mesentery is an arrest of rotation of the primary intestinal loop at 180°. The root of the mesentery is very short and the whole small intestine is located on the superior mesenteric artery axis. Patients are at very high risk of small bowel volvulus and enteromesenteric infarction. Acute volvulus requires emergency surgery; imaging must not delay surgery. Surgery is based on the untwisting of the volvulus (counterclockwise) after the assessment of intestinal viability. The intestine placed in the complete common mesentery position: the cœcum is situated in the right iliac region. We report the case of a 60-year old patient admitted with total small bowel volvulus on an incomplete common mesentery who underwent emergency surgery with favorable postoperative outcome.

Giant Mesenteric Lipoma Causing Small Bowel Volvulus: A Case Report.

BACKGROUND: A lipoma of the small bowel mesentery is a rare clinical entity. It rarely causes intestinal obstruction mainly due to volvulus. CASE: We report a case of a 25 years old male who presented with acute exacerbation of abdominal pain, nausea and vomiting. Plain abdominal x-ray showed complete small bowel obstruction. At laparotomy, there was small bowel volvulus with a big yellow mass as an axis. Enbloc resection and end-to-end ileal anastomosis was done. CONCLUSION: Mesenteric lipoma are rare. They should be considered in cases of long standing abdominal pain.

Transverse colon volvulus in a patient with sickle cell disease.

Although colonic volvulus is a relatively rare cause of large bowel obstruction, accounting for up to 5% of all cases of intestinal obstruction, transverse colon volvulus is extremely uncommon compared with volvulus of the sigmoid colon or caecum and is responsible for only 3% of all reported cases. We report an unusual case of spontaneous volvulus of the transverse colon in a young man with sickle cell disease who underwent resection with primary anastamosis. Having a high index of suspicion and early operative intervention allowed for this patient to have an uneventful postoperative course.

Rare copy number variants contribute pathogenic alleles in patients with intestinal malrotation.

BACKGROUND: Intestinal malrotation is a potentially life-threatening congenital anomaly due to the risk of developing midgut volvulus. The reported incidence is 0.2%-1% and both apparently hereditary and sporadic cases have been reported. Intestinal malrotation is associated with a few syndromes with known genotype but the genetic contribution in isolated intestinal malrotation has not yet been reported. Rare copy number variants (CNVs) have been implicated in many congenital anomalies, and hence we sought to investigate the potential contribution of rare CNVs in intestinal malrotation. METHODS: Analysis of array comparative genomic hybridization (aCGH) data from 47 patients with symptomatic intestinal malrotation was performed. RESULTS: We identified six rare CNVs in five patients. Five CNVs involved syndrome loci: 7q11.23 microduplication, 16p13.11 microduplication, 18q terminal deletion, HDAC8 (Cornelia de Lange syndrome type 5 and FOXF1) as well as one intragenic deletion in GALNT14, not previously implicated in human disease. CONCLUSION: In the present study, we identified rare CNVs contributing pathogenic or potentially pathogenic alleles in five patients with syndromic intestinal malrotation, suggesting that CNV screening is indicated in intestinal malrotation with associated malformations or neurological involvements. In addition, we identified intestinal malrotation in two known syndromes (Cornelia de Lange type 5 and 18q terminal deletion syndrome) that has not previously been associated with gastrointestinal malformations.

Pediatric Sigmoid Volvulus.

Sigmoid volvulus is an extremely rare cause of abdominal pain in children. More commonly seen in older adults, an SV occurs when a redundant loop of sigmoid wraps around its elongated, narrow mesentery causing obstruction and ischemia to the affected bowel segment. Children usually present with abdominal pain, nausea, and abdominal distension. Presentations may be acute or chronic with a history of episodic constipation or abdominal distension. The treatment plan includes an initial reduction of the volvulus via sigmoidoscopy with rectal biopsy to rule out Hirschsprung disease; however, operative management to remove the dilated sigmoid colon may be required in the setting of recurrence or confirmed Hirschsprung disease. Although rare, SV should be considered in a child presenting with abdominal pain as a missed diagnosis can have high potential morbidity and mortality.

Intestinal obstruction as a cause of death in the mentally disabled.

Two cases of intestinal obstruction in the mentally disabled are reported. The first case concerns 61-year-old oligophrenic woman who resided in a nursing home, where she was found hypotensive and unresponsive. Upon opening the peritoneal cavity at autopsy, extremely dilated (measuring on average 12 cm in diameter) loops of the colon emerged- they compressed the small intestine and other intraperitoneal organs, lifting both hemidiaphragms deep into the pleural cavity. Lodged firmly into the rectum, a partly disintegrated sanitary pad was found. In the second case, young man with Down syndrome was found dead in his room in a nursing facility. At autopsy, a massively dilated stomach and intestinal loops emerged, interposing one of the loops between the liver and right hemidiaphragm (pushing it to the 3rd intercostal space). This was caused by a volvulus - the cecum, the entire ascending colon and hepatic flexure were gangrenous, dilated (the maximum diameter was 15 cm) and twisted in a full circle around the mesenteric attachment. There were no signs of colon perforation. In both cases, intellectual disability was at the core of poor communication and delayed medical treatment, which led to a fatal outcome. Caregivers must be trained to recognize distress in the mentally disabled, especially since the symptoms and signs of gastrointestinal diseases may be subtle, or at least less recognizable. By performing careful physical examination medical staff should search more cautiously for these signs. Any suspicion of mistreatment or neglect of the mentally impaired requires a medico-legal investigation and autopsy.