Case Of Volvulus Research Articles

Preoperative diagnosis of gallbladder volvulus: Clinical case report and review of the literature

Introduction: Gallbladder volvulus is an uncommon disorder that impedes the circulation of fluid in the gallbladder and blood vessels. Gallbladder volvulus accounts for only 1 in 365,000 cases of gallstone disease. Wendell first described gallbladder volvulus and in the early 21st century, approximately 500 cases of gallbladder volvulus were reported as of early 2020. Despite technological advances in imaging modalities, the preoperative diagnosis of gallbladder volvulus remains very difficult with only 4 cases reported in the literature. Clinical case: We report a rare case of complete acute gallbladder volvulus diagnosed preoperatively in a woman. An elderly female patient came to the emergency room with symptoms of acute cholecystitis. Ultrasound shows signs of an enlarged gallbladder, thick walls, and fluid around the gallbladder. The gallbladder has no stones, the intrahepatic and extrahepatic bile ducts are not dilated, and there are no stones. Computed tomography also shows similar images, along with images of twisting in the neck of the gallbladder. The laparoscopic cholecystectomy was indicated as an emergency. During surgery, we found the gallbladder was twisted 180 degrees counterclockwise at the gallbladder funnel, congested and necrotic. The patient had no complications and was discharged from the hospital on the 4th day after surgery. Conclusion: Preoperative diagnosis of gallbladder volvulus is a challenge for clinicians. The combination of signs and symptoms with imaging findings can guide physicians to accurately and promptly diagnose preoperatively gallbladder volvulus. Early intervention helps prevent complications of sepsis due to gallbladder ischemia, necrosis and perforation, reducing mortality.

Prenatal-Postnatal Outcomes and Prognostic Risk Factors of Fetal Volvulus: Analysis of 26 Cases.

The aim of the current study was to reveal ultrasonographic and clinical features, prenatal-postnatal outcomes and prognostic risk factors of fetal volvulus. This retrospective study evaluated all cases of fetal volvulus diagnosed between 2018 and 2024 at the Perinatology center of Zeynep Kamil Women and Children Diseases Training and Research Hospital. In the vast majority of cases, the pediatric surgery team confirmed the conclusive diagnosis of volvulus during the postnatal period. The cohort was divided into two groups, the "survivor" and "deceased", in order to compare the outcome and to evaluate factors determining the outcome. A total of 26 cases of fetal volvulus were followed up in our perinatology center which were confirmed by postnatal pediatric surgery or autopsy. Termination of pregnancy in two cases and intrauterine fetal death in one case were observed. Twenty-three cases reached live birth. Preterm labor, fetal growth restriction, ascites and decreased intestinal peristalsis were significantly more common in the deceased group. Neonatal death in five cases (19.2%), infant death in four cases (15.3%) and short gut syndrome in three cases (11.5%) were long term outcomes. Overall mortality rate may increase when fetal growth restriction, ascites, and decreased intestinal peristalsis are present with volvulus.

A Case of Cecal Volvulus in the Setting of Multiple Sclerosis

A Case of Cecal Volvulus in the Setting of Multiple Sclerosis

Debating and Expanding on the Midgut Volvulus Case: A New Perspective

Since midgut volvulus is a rare but serious condition featuring twisted intestines, this presents significant problems with diagnosis and treatment- especially for adults. Early diagnosis and swift action are important in preventing such complications as juxtaposition of the bowel loops with volvulus, necrosis, etc. This study is based on recent developments of a case documented in then Jordanian American Physicians Academy Journal, and makes clear the difficulties involved in diagnosing midgut volvulus in a patient with cavernous transformation of the portal vein. Entering oublic health and reaching out to each discipline, means T.The fact that this study involved adult and pediatric cases demonstrates the need for advanced imaging technology and individualized treatment plans in order to improve patient outcomes.

Gastric volvulus in children: diagnosis and treatment approaches

Gastric volvulus is a sporadic disease in the pediatric age group and is very complex in terms of etiology and management. In this study, we aimed to discuss two late-diagnosed gastric volvulus cases, review the diagnosis and treatment methods of gastric volvulus cases in the pediatric age group encountered in the literature, and reduce concerns about the correct diagnostic approach to these cases. The first case was an 8-year-old girl who was followed up due to developmental delay and metabolic disease and was admitted due to recurrent vomiting attacks. The endoscopic reduction was first performed on the patient whose upper gastrointestinal tract imaging was compatible with organoaxial gastric volvulus. Since vomiting attacks continued, laparoscopic gastropexy was performed. In the postoperative follow-up, there was weight gain and vomiting complaints wholly regressed. The second case was a 1-year-old girl who was treated for gastroesophageal reflux at an external center due to vomiting and developmental delay, but she did not receive any response. The endoscopic reduction was performed because the patient's upper gastrointestinal imaging was compatible with the organoaxial gastric volvulus. Laparoscopic gastropexy was performed on the patient whose vomiting recurred. The stomach was expected to be seen in the upper passage imaging in the postoperative period. In the systematic search made in the MEDLINE/Pubmed database using the keywords "gastric volvulus and pediatric," 41 literature articles presenting 47 cases between 2013 and 2023 were included. The patient's age, gender, complaints at admission, type of gastric volvulus, and treatment-related data were collected. The most common symptoms in the patients were vomiting, and abdominal pain and the most common comorbidities were diaphragmatic pathologies and wandering spleen. The most preferred treatment was anterior gastropexy. Gastric volvulus is characterized by vomiting, abdominal pain, and developmental delay. It is tough to diagnose, especially in chronic cases. In addition to the conservative approach in chronic cases, anterior gastropexy should be preferred to prevent recurrent volvulus attacks.

Association of mesenteric volvulus in police working dogs with and without a prior prophylactic laparoscopic gastropexy.

To evaluate the association of mesenteric volvulus (MV) in New York Police Department police working dogs (PWDs) with and without a prior prophylactic laparoscopic gastropexy (PLG). 370 PWDs (82 with and 288 without PLG). Medical records and surgery and radiology reports were reviewed from 2012 to 2022. Signalment, pertinent history (medical and surgical), gastropexy status, temperament, and training type were recorded. Statistical analysis was used to identify the relationship between prophylactic gastropexy and MV within the patient population. 3 cases of mesenteric volvulus were noted in this patient population. Two (2.4%) of the 82 PWDs that had undergone prophylactic laparoscopic gastropexy developed MV, whereas 1 (0.3%) of the 288 PWDs that had not undergone a gastropexy procedure developed MV. Police working dogs with PLG were estimated to be at 7.2 times greater odds of MV (point estimate OR, 7.18; 95% CI, 0.642 to 80.143); however, the low incidence of MV in this population limited statistical power, and thus this effect did not achieve statistical significance. Evaluation of MV incidence in additional populations of working dogs will allow greater precision in the point estimate. Prophylactic gastropexy may be associated with an increased risk for MV. However, patients without prophylactic gastropexy are at risk for gastric dilatation and volvulus, which is more common than MV. Therefore, the authors continue to recommend prophylactic gastropexy to decrease the risk for gastric dilatation and volvulus.

Gallbladder volvulus by laparoscopic surgery

Gallbladder volvulus has a higher incidence between the sixth and eighth decades of life, exceptional condition for its infrequence. Since it tends to be confused with other pathologies, its diagnosis is usually intraoperative and can cause serious complications, such as gangrene, biliary sepsis and even death. We present the case of a 97-year-old patient who went to the emergency department with abdominal pain in the epigastric region, oppressive, irradiated to the right hypochondrium. Due to laboratory and imaging findings, a laparoscopic cholecystectomy was decided. During the surgery, a gallbladder volvulus was observed. The patient presented a satisfactory postoperative evolution, being discharged after 48 hours. This article presents a clinical case of vesicular volvulus and its proper laparoscopic management.

Outcome of Resection and Primary Anastomosis in Uncomplicated Sigmoid Volvulus

Background: Sigmoid volvulus is a critical surgical condition characterized by the twisting of the sigmoid colon along its long axis, primarily affecting elderly male patients. The condition often necessitates surgical intervention to relieve the life-threatening obstruction. Objective: This study aimed to evaluate the outcomes of resection and primary anastomosis as the preferred surgical approach for uncomplicated sigmoid volvulus cases, excluding those with perforation or gangrene. Methods: A prospective observational study was conducted on 40 patients meeting specific criteria, involving structured data collection, hand-sewn resection, and primary anastomosis. Postoperative follow-ups were performed at 24 and 6 weeks, and data were analyzed using SPSS. Results: The study found a mean patient age of 56.25 years, with a predominant male population (male-to-female ratio: 9:1). Common symptoms included abdominal distension, constipation, colicky abdominal pain, vomiting, and urinary retention. Complications, observed in 27.5% of patients, included wound infections, wound dehiscence, anastomotic leakage, pelvic abscess, and prolonged paralytic ileus. A 95% survival rate was noted, with 80% of patients staying in the hospital for 10 days or more. The mean hospital stay was 10.77 days (range: 7-19 days). Conclusion: Resection and primary anastomosis is a safe and effective single-stage procedure for uncomplicated sigmoid volvulus cases, resulting in better outcomes, shorter hospital stays, and avoidance of a staged operation without increasing morbidity and mortality.

Pregnant with Acute Abdomen, an Unexpected Turn: Gallbladder Volvulus Case Report

Gallbladder volvulus, is a rare condition that occurs when the gallbladder twists on its elongated mesentery along the axis of the cystic duct and artery, it occurs in 1 in every 365,000 cases, the mortality of this condition is of 6%. Its clinical presentation is insidious and patients usually go to the emergency department with an acute abdomen. We present the clinical case of a pregnant patient who came with data of acute abdomen, protocolized and operated on by our service with an unexpected outcome: volvulated gallbladder.

Cecal Volvulus Presenting after Onset of Acute Pancreatitis: A Case Report

Cecal volvulus is a rare, potentially life-threatening cause of large bowel obstruction (LBO). Discerning LBO in the background of chronic episodes of epigastric or abdominal pain ensures timely treatment and reduces the risk of complications. Atypical demographic presentation may pose a clinical danger that can be best avoided with standardized diagnostic imaging. We report a case of cecal volvulus in a male patient with a history of alcohol use disorder and pancreatitis. The patient underwent a right hemicolectomy with small bowel resection and primary anastomosis.

Congenital mesenteric defect with distal ileal atresia and segmental volvulus in a neonate: A case report

Intestinal volvulus is a rare condition that can be life-threatening. It often occurs after birth and requires emergent surgery. Most cases of volvulus in infants and fetuses are linked to intestinal malrotation. However, Intestinal volvulus may occur even if the midgut is in normal position, due to mesenteric defects. We present the case of a A 2-day-old, female phenotype neonate who presented with recurrent episodes of bilious vomiting. Clinical and radiological presentation was consistent with distal intestinal atresia. In Surgical exploration, we found a segmental volvulus of the terminal ileum complicating a congenital mesenteric defect and associated with a distal ileal atresia. An ileo-caecal resection was performed as well as a resection of the dilated distal bowel. Then an ileo-colic end-to-end anastomosis was done followed by closure of the mesenteric defect. Postoperative course was uneventful. Mesenteric defects can lead to segmental intestinal volvulus even when the midgut is normally rotated. Treatment should be tailored according to the anatomy and bowel status of the patient.

Intestinal Torsion and Volvulus Through a Mesenteric Rupture in a Bearded Dragon (Pogona vitticeps)

A female spayed bearded dragon (Pogona vitticeps) of unknown age presented with a 48-hour history of anorexia and lethargy. On presentation, the patient had a black beard, sunken eyes and a full coelomic cavity on palpation, although no specific thickening or masses were noted. Diagnostic investigations were conducted in the form of radiographs and ultrasonography. The owner elected euthanasia due to deterioration in the patient’s condition. Gross and microscopic post-mortem examination revealed a torsion and volvulus of the gastrointestinal tract through a rupture in the mesentery, with marked red/black, segmental discolouration to the intestines. Limitations of this study include no further diagnostic tests other than imaging and decision to euthanise hindering the ability to explore surgical correction. To the authors’ knowledge, this is the first reported case of intestinal torsion and volvulus through a mesenteric rupture in a bearded dragon.

Cecal volvulus with intestinal malrotation: a rare cause of bowel obstruction

Introduction:Cecal volvulus is a rare cause of acute abdomen in adults. It accounts for less than 1% of intestinal obstructions and 25-30% of cases of colonic volvulus. Congenital intestinal malrotation is a complex disorder due to incomplete or faulty rotation and fixation of the gut during the fetal life.Cecal volvulus associated with intestinal malrotation is a very rare presentation. Over 16 cases were reported in the literature. Case report:A 44-year-old man with no medical history, presented to the emergency department with a 2-day history of abdominal pain and bloating. On clinical examination, the abdomen was distended and tympanic to percussion, with diffuse abdominal tenderness. Abdominal X-ray (standing) showed a distended large intestine with an airfluid colonic level. CT scan showed a markedly dilated cecum measuring up to 14 cm, which were located in the left hypochondrium. A “whirl sign” and a superior mesenteric pedicle swirl were also noted. Emergency surgery was performed. Intraoperative exploration revealed a cecal volvulus with a largely distended hypermobile cecum located in the left hypochondrium, with preischemic signs within its wall. All the small gut was right-sided and the large gut left-sided, suggestive of mesenterium commune and intestinal malrotation. A right hemicolectomy withileo-transverse anastomosis was done. The postoperative course was uneventful. The patient is on regular follow up and is doing well. Conclusion:We describe a rare case of surgical management of cecal volvulus associated with intestinal malrotation in a middle-aged patient with no medical history. This case highlights the importance of early diagnosis by physical examination and radiological findings to prevent serious complications. Emergent surgery was the key to this successful management and surgical resection could offer better results with lesser recurrence rate. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 445-448

Sigmoid volvulus and diabetes mellitus.

Diabetes mellitus (DM) complicates about 15.7% of sigmoid volvulus (SV) cases. However, the pathophysiology of this relation is still unclear. Our objective was to evaluate the association of DM and SV. The clinical data of 1,051 patients treated in Ataturk University Faculty of Medicine during 56 years between June 1966 and July 2022 were considered. The records of 612 cases (58.2%) were evaluated retrospectively till June 1986, while 439 (41.8%) were investigated prospectively thereafter. To obtain the worldwide data, an electronic search of the last 56-years' literature (from 1967 to date) was performed in Web of Science and PubMed databases. DM was statistically higher in SV patients than of general population (15.7% vs. 8.3%, p<0.001). Conversely, SV and DM co-occurrence was statistically lower in our series than of world-wide data (2.9% vs. 15.7%, p<0.001). In our series, SV and DM comorbidity was statistically higher in elders that that of children (3.9% vs. 0.0%, p<0.05). Although sigmoid gangrene was more common in DM patients when compared with that of total, the difference was not statistically significant (42.9% vs. 27.4%, p>0.05). Conversely, the mortality rate was statistically higher in DM cases than that of no diabetics in SV (28.6% vs. 7.8%, p<0.001). Although the pathophysiology of SV and DM comorbidity is still relatively unexplainable, our study suggests that DM worsens the prognosis of SV. For this reason, early diagnosis and proper treatment have great importance in such patients.

Ileostomy volvulus as an underreported problem causing small bowel obstruction in patients living with ostomy: a case report and literature review.

Ileostomy volvulus is a rare cause of small bowel obstruction. We present an unusual case of ileostomy volvulus without the presence of adhesions. Additionally, a systematic literature review was performed to collate the current literature on the causes, diagnosis, treatment, and preventative measures of ileostomy-related small bowel obstruction. PubMed (MEDLINE), Embase, Google Scholar, Scopus, and CENTRAL were searched from their inception up to August 2022. This study adhered to the PRISMA guidelines and was registered on PROSPERO. The primary outcomes included patients' demographics, imaging modality, indication for initial surgery, type and configuration of stoma, surgical treatment, and recurrence of volvulus. The quality of included studies was assessed using the Murad tool. Written informed consent was obtained from the patient. Seven studies were included, comprising 967 patients. Stoma outlet obstruction (SOO) was reported in all 159 patients, and 12 had ileostomy volvulus as the cause. A majority of patients had loop ostomies for ileostomy volvulus. No complications or mortality were reported in the included studies, and half of the included studies were deemed to be of good quality. This case demonstrates the need for high clinical suspicion of SOO in patients with loop ileostomy, and rapid management should be undertaken. Whilst loop ileostomies, increased rectus abdominal muscle thickness, and lower preoperative total glucocorticoid dosage are associated with SOO, large-scale retrospective studies are needed to validate our findings.

Caecal Volvulus

Caecal volvulus is favoured by the lack of caecal adhesion and intestinal malrotation. According to the per operation findings, the treatment consists of a de-rotation with or without cecopexy. We present the three cases of caecum volvulus in children and discuss our management. Case 1: 11-year-old girl admitted for caecal volvulus in an acute occlusive syndrome picture. There was caecal volvulus and atresia of the volvulated area. We performed resection and end-to-end anastomosis. Good evolution. Case 2: 6-year-old girl admitted for caecal volvulus in an acute occlusive syndrome picture. We performed caecopexy at the right parietal-colic gutter by three interrupted stitches. Good evolution. Case 3: 6-year-old girl admitted for caecal volvulus in an acute sub-occlusive syndrome picture with hypovolemic choc stage. There were suffering areas and necrosis of the caecum, a part of the ascending colon and iléal loops. We resected the gangrene part of the digest if tract and performed end-to-end ileocolic anastomosis. Good evolution. Caecal volvulus is rare. In our series, a patient had an ultrasound diagnosis. The diagnosis of caecum volvulus was made by computed tomography scan to the second one. The third patient had a perioperative diagnosis which is frequently reported in the literature. Management varies from the simple de-rotation with appendectomy to caecopexy. Caecal volvulus is a therapeutic emergency because the risk of necrosis and perforation is obvious. With proper support, the overall evolution is good.

Robotic-assisted laparoscopic management of mesenteric cysts in children.

Mesenteric cysts (MCs) are rare intra-abdominal masses in children, and laparoscopic complete cyst resection is still difficult. This study reviewed our experience in diagnosing and managing MCs at our center, focusing on the clinical characteristics of MCs and the effectiveness of robotic-assisted laparoscopic surgery. We conducted a retrospective analysis of the records of all patients diagnosed with MCs and managed with robotic-assisted laparoscopic surgery at our center between February 2021 and August 2022. We analyzed demographic characteristics, clinical manifestations, preoperative imaging data, surgical methods, postoperative complications, and final outcomes. Totally, 12 consecutive patients with a mean age of 5.81 ± 3.02 years were admitted. The most common symptom was abdominal pain (58.33%). Eight patients were associated with cyst complications, including five cases of infection, two cases of volvulus, and one case of hemorrhage. The mean size of cysts was 8.39 ± 5.91 cm. The cysts were located in ileal mesentery in eight cases, lesser curvature of the stomach in two cases, and colon mesentery in two cases. Solely cyst excision was performed in eight cases, and bowel en bloc resection of the cyst in four cases. Robotic-assisted laparoscopic surgery was performed successfully in all patients, without conversion. The mean operation time was 106.17 ± 33.74 min. Pathological results reported lymphangioma or lymphatic malformation in all patients. Two cases of chylous leakage were treated conservatively, and no complications of peritoneal infection, anastomotic leakage, and recurrence were observed. Mesenteric cysts should be removed promptly once the diagnosis is confirmed to avoid cyst complications. For uncomplicated mesenteric cysts, laparoscopic cyst excision, or cyst excision with bowel resection can be effectively performed in children, especially under the robot system.

A Rare Case of Antenatal Volvulus and its Management

Fetal intestinal volvulus is rare surgical condition associated with high rates of intrauterine, perinatal, and postnatal mortality. The exact incidence of this rare condition has not yet been described in the literature. This emergency surgical condition is associated with high morbidity and mortality if left unattended or unsuspected. One such rare case and its management has been discussed here.

A Case of Sigmoid Volvulus Treated with Surgery in a Young Patient

Genç bir hastada kolonoskopik detorsiyon ile tedavi edile- meyen ve cerrahi rezeksiyon gerektiren sigmoid volvulus ol- gusunun tanı ve tedavi sürecinin sunulması amaçlanmıştır. Yirmi yedi yaşında erkek hasta karın ağrısı, şişkinlik ve kusma ile birlikte bulantı şikayetleri ile başvurdu. Karın fizik muaye- nesinde karın ağrısı, defans, her kadranda rebound ve abdom- inal distansiyon mevcuttu. Parmakla rektal muayenede dışkı kontaminasyonu yoktu. Laboratuvarda sadece c-reaktif pro- tein düzeyi (CRP) (14,1 mg/L) yüksekti. Bilgisayarlı tomografi (BT) taraması, sigmoid volvulus nedeniyle dilate kolon hal- kaları gösterdi. Kolonoskopi ile detorsiyon başarılı olamadığı için hastaya acil ameliyat uygulandı. Cerrahi sırasında, üst sig- moidal bölgede 7200 'lik bir torsiyon vardı; tüm kolon ansları 10 santimetreye kadar aşırı derecede genişlemişti. End ileostomi ile total kolektomi yapıldı. Hasta postoperatif dördüncü günde komplikasyonsuz olarak taburcu edildi.

Acute abdominal pain due to sigmoid volvulus with persistent descending mesocolon: a case report

BackgroundPersistent descending mesocolon, an anomaly of fixation of the mesentery of the descending colon, can sometimes cause complications such as intestinal obstruction and intussusception. We present the first reported case of sigmoid volvulus with persistent descending mesocolon.Case presentationAn 82-year-old Japanese man had intermittent lower abdominal pain. Abdominal computed tomography showed dilation and a shift to the right side of the sigmoid colon, but no findings of volvulus. The next day, he presented continuous lower abdominal pain with bloody stool. A second abdominal computed tomography showed strangulation and dilation of the sigmoid colon, with shift from the right side of the abdominal cavity to the pelvic space. This suggested the descending colon was running to the medial side with sigmoid volvulus. Emergency surgery was performed for volvulus with persistent descending mesocolon. Operative findings revealed dilation of the sigmoid colon with a partial poorly colored region and strangulation that caused volvulus. After releasing the strangulation of the sigmoid colon, the descending colon was revealed to be running more to the medial side, with adherence to small intestinal mesentery. There was no Toldt’s fusion fascia at the descending colon. Persistent descending mesocolon was therefore diagnosed due to abnormality of fixation of the descending colon. The sigmoid colon, including the poorly colored region, was resected and reconstructed, while the inferior mesenteric and left colonic arteries were preserved because of the complexity of the vascular system running around the descending and sigmoid colon due to the shortened mesentery. These findings were pathologically compatible with circulatory compromise and intestinal degeneration due to sigmoid volvulus. The patient had no complications after discharge, including in relation to defecation.ConclusionPersistent descending mesocolon can occasionally cause acute abdominal symptoms requiring immediate treatment. A computed tomography finding of the descending colon running more to the medial side than ordinary cases can aid diagnosis of persistent descending mesocolon.