Endoscopic Derotation Research Articles

Comments on 'Percutaneous gas decompression can ease endoscopic derotation in sigmoid volvulus'.

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Reply on Comments on A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation

Reply on Comments on A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation

Comments on ‘A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation’

Comments on ‘A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation’

A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation

A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation

Synchronous volvulus of the sigmoid and transverse colon in a 26-year-old male

We present a 26-year-old male patient who presented with complete bowel obstruction and peritonitis. His abdominal X-rays showed grossly distended large bowels with air–fluid levels. A differential diagnosis of sigmoid volvulus was entertained and the patient was taken for an exploratory laparotomy. Intraoperatively, we found a sigmoid volvulus and a concurrent transverse colon volvulus. A subtotal colectomy and colostomy was performed. The histopathology results showed mucosal and submucosal congestion, chronic inflammation, and no malignancy or dysplasia. Synchronous volvulus of the sigmoid and transverse colon is an extremely rare. Management includes endoscopic derotation and decompression followed by semi-elective surgery in non-complicated cases. When endoscopic decompression has failed or there is suspicion of necrosis or perforation, surgery is mandatory.

Thymoma with acute gastric volvulus: a case report

BackgroundAcute gastric volvulus (GV) is a rare disease with high mortality rate often associated with anatomic abnormalities. Thymoma is the most common neoplasm located in the anterior mediastinum. There is no reported relationship between thymoma and GV. Here we reported a case of thymoma with initial symptom of acute gastric volvulus.Case presentationA 43-year-old man complained of postprandial abdominal pain, nausea and vomiting. Acute gastric volvulus was diagnosed by chest radiograph, upper digestive tract radiograph and CT scan; later type B3 thymoma was diagnosed by biopsy of mediastinal mass. We inferred that gastric volvulus was secondary to thymoma due to phrenic nerve palsy. The patient was treated with endoscopic de-rotation. Further radiotherapy and chemotherapy were given. During treatments, GV still occurred with less severity and a reduced frequency of approximately every three to four months.ConclusionWe report the first case of thymoma initially presented with acute GV. We suspect a pathological mechanism related to the phrenic nerve palsy. This case indicates that thymoma may present alongside rare acute GV.

A rare case of post-splenectomy gastric volvulus managed by laparoscopic anterior gastropexy.

We report an extremely rare case of recurrent gastric volvulus after open splenectomy for hereditary spherocytosis. The initial episode was managed by endoscopic derotation. Later, for recurrent symptoms, she was successfully managed by laparoscopic anterior gastropexy.

Observations on a Giant Sigmoid Volvulus with Unusual Clinical Presentation and Challenging Postoperative Course: Case Report

Introduction: The present report describes a case of a giant sigmoid volvulus (SV) where acute respiratory distress was associated with toxic megacolon. Clinical features, surgical treatment and postoperative course deserved our attention and discussion. Presentation of Case: A 67-year-old man with psychiatric disturbances was admitted to our Department with severe respiratory distress due to an enormous abdominal distension caused by a sigmoid volvulus. Endoscopic derotation was unsuccessful and surgery immediately performed. After a wide colonic resection the patient underwent a prolonged treatment in the Intensive Care Unit. Death occurred 34 days after the operation for secondary infection of peritoneal effusion. Discussion: Main clinical features of SV pertain to abdominal compartment while in the present case acute respiratory distress was the prominent symptom; in the same time the severity of the case was due to the association of high abdominal pressure together with a toxic megacolon. Postoperative treatment consisted in ventilatory support, with a progressive shift from asssisted to spontaneous ventilation; repeated sessions of haemodialysis were necessary to manage renal failure up to recovery of the urine output. Bacterial trans location due to toxic megacolon was responsible of late infection of ascitic fluid. In spite of multiple antibiotic association according to bacterial cultures, intra-abdominal abscesses eventually developed causing fatal outcome 34 days after the first intervention. Conclusion: Severe clinical presentation required a prolonged and demanding postoperative course which was focused on the recovery of respiratory, cardiac and renal function even if fatal outcome was due to septic complications. Suspicion of late infection of ascitic fluid could arise from persistently high values of inflammation indexes and drive to an earlier drainage of the abdominal abscesses.

Intractable Nausea and Vomiting and Weight Loss in a Young Adult: A Rare Diagnosis to Consider

Introduction: Anteriomedial diaphragmatic defect -Morgagni hernia- accounts for less than 5% of all congenital diaphragmatic hernias (CDH). Presentation can occur in elderly females (sixth decade of life) or in the first decade of life with respiratory, cardiovascular, or gastrointestinal symptoms. Colon, small bowel, liver, and stomach herniation into chest cavity have been reported. Gastric volvulus is an extremely rare presentation. A 35-year-old black male presented with 2-3-month history of persistent postprandial nausea and vomiting, epigastric pain, early satiety, and 25-lb weight loss. Physical exam showed dry mucous membranes, scleral icterus, and decreased air entry to the right lower lung field. Acute abdominal series showed an air-fluid level in the right hemithorax and normal bowel-gas pattern. Computed tomography scan showed partial gastric outlet obstruction due to entrapment of the gastric antrum in a large Morgagni type hernia with partial volvulus. Esophagogastroduodenoscopy (EGD) showed dilated stomach and encountered resistance passing the endoscope past the duodenal bulb. A nasojejunal tube was subsequently placed for decompression. After fluid resuscitation and electrolyte replacement, he underwent laparoscopic reduction of the stomach and mesh repair of Morgagni’s defect. He had a smooth postoperative course and gained 10 lbs at 2-month follow-up. Herniation of abdominal contents into the thoracic cavity through the foramen of Morgagni is a rare clinical condition in adults, accounting for only 3% of all treated diaphragmatic hernias. Gastric volvulus is quite rare, and is classified based on the rotational axis: organoaxial rotation of the stomach along the long axis connecting gastroesophageal junction (GEJ) and pylorus, or mesenteroaxial rotation of the stomach along the short axis connecting lesser and greater curvatures. The latter is less common, and results in antral displacement above the GEJ. Our patient had partial mesenteroaxial volvulus in the setting of Morgagni hernia. While acute presentation is a surgical emergency, chronic presentation, as in our patient, can be managed conservatively or surgically, depending on the severity of their symptoms, life expectancy, and comorbidities. EGD can be diagnostic and therapeutic through endoscopic de-rotation in primary volvulus, but initial management should focus on fluid and electrolyte replacement, gastric decompression with nasogastric tube placement, surgical intervention for hernia reduction, de-rotation of stomach, and defect closure by approximation or mesh repair. Prompt recognition of this condition is imperative, and initial chest and abdominal plain films can point towards this diagnosis.

Emergency resection of sigmoid volvulus

To determine the outcome of emergency resection of sigmoid volvulus and to determine the factors associated with adverse outcome. Retrospective case series review. Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. All cases of sigmoid volvulus operated at MTRH during the six years period between year 2000-2005. Mortality rate; morbidity rate; and duration of hospital stay. Ninety two case files were analysed. Sigmoid volvulus accounted for 14.1% of all cases of intestinal obstruction and 80% of large gut obstruction. The mean age was 47.3 years and the median was 50 years. The range was 16 to 86 years. The male to female ratio was 29.3:1. Mortality was three (3.3%) cases and the morbidity was 20 (21.7%) cases. The mean duration of hospital stay was 11.8 days. Inadequate intravenous fluid therapy had a statistically significant adverse effect on outcome in this study. The yearly outcome remained unchanged during the six years of the study. Emergency resection in cases with a viable colon had a similar outcome to the traditional standard treatment by emergency endoscopic derotation followed by semi-elective or elective resection. The overall outcome was comparable to global standards. Inadequate postoperative intravenous fluid therapy significantly affected the outcome.

Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly: A study of 33 cases

To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. A retrospective review of the clinical presentation and imaging characteristics of 33 sigmoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review. In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigmoid, Hartmann's procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage "on table" prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay (3 to 8 d after the deflation). All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigmoidopexy and one patient underwent a near-total colectomy. Two patients (sigmoidectomy-sigmoidopexy) had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had only one death (5.9%), whereas after 15 emergency operations 6 patients died, which means a mortality rate of 40%. Although sigmoid volvulus causing intestinal obstruction is frequently successfully encountered by endoscopic decompression, however, the principal therapy of this condition is surgery. Only occasionally in patients with advanced age, lack of bowel symptoms and multiple co-morbidities might surgical repair not be considered.