Volvulus Research Articles

Gastric dilatation volvulus: a review

Gastric dilatation volvulus is a common life-threatening condition experienced by dogs. A distended stomach and rotation of the stomach about its axis causes severe adverse haemodynamic effects, and the disease can have a poor prognosis. Veterinary nurses are crucial in the recognition of symptoms during triage as well as aiding diagnosis, treatment and postoperative management. This article reviews the pathophysiology of the condition, clinical presentation, diagnosis, treatment, prognosis and client education.

US for Evaluation of Acute Abdominal Conditions in Neonates

US is the imaging modality of choice for evaluation of a variety of abdominal conditions, and in recent years it has also become useful and promising as a bedside technique for assessment of acute abdominal conditions in neonates. Bedside US can help, complement, and sometimes replace radiographic or contrast-enhanced studies in critically ill and labile neonates who are difficult to transport to the fluoroscopy suite. Some of the features of bedside US can be applied as point-of-care US (POCUS) of the sick neonate. Some of the abdominal conditions in neonates that can be assessed and monitored with bedside US are necrotizing enterocolitis and its complications, malrotation with a midgut volvulus, segmental volvulus, meconium peritonitis, and complicated inguinal hernia. High-resolution US with the use of 15-MHz and higher-frequency probes allows characterization of the bowel anatomy and features of intestinal abnormalities in neonates in fine detail. Color Doppler US and microvascular imaging improve accuracy in the detection and characterization of bowel vascularity, which is important in the treatment and follow-up of patients with intestinal conditions. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. The slide presentation from the RSNA Annual Meeting is available for this article.

Cecal Volvulus: An Uncommon Diagnosis in a Child with Down's Syndrome.

Cecal Volvulus: An Uncommon Diagnosis in a Child with Down's Syndrome.

Congenital Intestinal Malrotation in Newborns: Laparoscopic Ladds Procedure versus Open Laparotomy

To assess the efficacy and safety of laparotomic or laparoscopic Ladd's procedure in newborns with congenital malrotation. Descriptive study. Department of Pediatric Surgery, Ganzhou Maternal and Child Health Care Hospital, Ganzhou JiangXi province, China, from January 2015 to December 2021. The clinical data of newborns with malcorrection were retrospectively analysed. Patients were divided into laparotomy group (64 cases) and laparoscopy group (30 cases), according to the surgery they had been subjected. The patients who had the severe malformations, underwent the laparoscopic Ladd's procedure at the first 10 cases, and had found bowel necrosis during operation were excluded. The general data such as lengths of operation, intraoperative blood loss, time-to-diet, lengths of hospital stay, and postoperative complications were compared between the two groups. Crude comparisons showed that the laparoscopy increased the lengths of operative time (70.0 vs. 110.0 minutes, p <0.001) but decreased the postoperative complications (25.0% vs. 6.7%, p=0.035). The intraoperative blood loss, time-to-diet, and lengths of hospital stay between the two groups were not statistically significant (p=0.109, 0.065, and 0.858 respectively). The intestinal volvulus in the two groups (43.8% vs. 80.0%, p=0.001) had statistical differences. Using modified Poisson regression analysis, adjusting for confounding differences of midgut volvulus, lengths of operation time and intraoperative blood loss, and laparoscopic Ladd's showed a significant decrease in postoperative complications (RR=0.13,95%CI 0.03-0.54, p=0.005). Laparoscopic Ladd's procedure is feasible to treat neonatal malrotation and is associated with lower postoperative complications of newborns with congenital malrotation. Newborns, Congenital malrotation, Laparoscopy, Laparotomy, Complications.

Surgical correction of mid gut volvulus presenting as acute intestinal obstruction and multiple jejunal diverticula with sealed off perforation-a case report

Multiple diverticulosis of the jejunum is an uncommon pathology of the small bowel. The incidence of diverticulum of small intestine varies from 0.3 to 1.2%, out of which duodenal diverticula are common that jejunal. This rare jejunal diverticula is usually asymptomatic in course, which made it more difficult in establishing this diagnosis. This may rarely lead to complications such as perforation, haemorrhage, obstruction which may be due to adhesions, volvulus, and intussusception. We herein report a case of a 72-year-old female patient with no comorbidities presented to ER with complaints of abdominal distention, lower abdominal pain, vomiting for 3 days. Pre-op evaluation revealed midgut volvulus with intestinal obstruction. Explorative Laparotomy revealed multiple diverticula in jejunum. Midgut volvulus was operated by resection and anastomosis of small bowel.

158 - Chronic gastric volvulus as a rare cause of iron deficiency anemia

158 - Chronic gastric volvulus as a rare cause of iron deficiency anemia

Midgut Volvulus Adds a Murine, Neutrophil-Driven Model of Septic Condition to the Experimental Toolbox

Severe infections that culminate in sepsis are associated with high morbidity and mortality. Despite continuous efforts in basis science and clinical research, evidence based-therapy is mostly limited to basic causal and supportive measures. Adjuvant therapies often remain without clear evidence. The objective of this study was to evaluate the septic volvulus ischemia-reperfusion model in comparison to two already established models and the role of neutrophil extacellular traps (NETs) in this model. The technique of the murine model of midgut volvulus was optimized and was compared to two established models of murine sepsis, namely cecal ligation and puncture (CLP) and intra-peritoneal (i.p.) injection of lipopolysaccharide (LPS). Midgut volvulus for 15 min caused a comparable mortality (38%) as CLP (55%) and peritoneal LPS injection (25%) at 48 h. While oxidative stress was comparable, levels of circulating free DNA (cfDNA), and splenic/hepatic and pulmonary translocation of bacteria were decreased and increased, respectively at 48 h. DNases were increased compared to the established models. Proteomic analysis revealed an upregulation of systemic Epo, IL-1b, Prdx5, Parp1, Ccl2 and IL-6 at 48 h in comparison to the healthy controls. Midgut volvulus is a stable and physiological model for sepsis. Depending on the duration and subsequent tissue damage, it represents a combination of ischemia-reperfusion injury and hyperinflammation.

Cecal volvulus secondary to gastric band surgery

Cecal volvulus is a rare complication following gastric band surgery. Continuous progress in surgical technique of adjustable gastric banding and the increasing experience of surgeons has decreased the rate of complications. However, because different complications may have the same clinical presentation but require different treatment, to give a definitive diagnosis radiologist must be aware of this complication as it can be fatal to patient if remains undiagnosed or misdiagnosed.

Gastric volvulus associated with shrinkage of a gastrointestinal stromal tumor by neoadjuvant imatinib: a case report

BackgroundDuring neoadjuvant chemotherapy for giant gastrointestinal stromal tumors, changes in gastrointestinal stromal tumor size are rarely associated with events such as perforation and bleeding that require emergency surgery. Moreover, it is very rare for gastrointestinal stromal tumors to shrink and become mobile, resulting in gastric volvulus. Herein, we report a case of gastrointestinal stromal tumor shrinkage during neoadjuvant imatinib treatment, resulting in gastric volvulus that required surgery. To the best of our knowledge, this is the first reported occurrence of gastric volvulus during neoadjuvant imatinib treatment for a giant gastrointestinal stromal tumor.Case presentationA 58-year-old Japanese woman who was diagnosed with a giant gastric gastrointestinal stromal tumor and administered neoadjuvant imatinib presented to our hospital with complaints of abdominal pain and retching. Enhanced computed tomography revealed that the gastrointestinal stromal tumor had shrunk and shifted in position, and the stomach had organoaxially twisted. Accordingly, the patient was diagnosed with gastric volvulus caused by a gastric gastrointestinal stromal tumor. Conservative treatment did not improve the volvulus; hence, laparotomy was performed. The tumor developed from the lesser curvature of the stomach and caused rotation of the gastric body. The local gastric wall was resected. Histopathological examination confirmed the diagnosis of gastrointestinal stromal tumor. The patient received adjuvant imatinib for 3 years and has been alive for 5 years without recurrence.ConclusionsGastric volvulus can be caused by the laxity of the ligaments that hold the stomach and gastric ptosis or esophageal hernia and diaphragmatic hernia; therefore, gastric gastrointestinal stromal tumors rarely cause gastric volvulus. However, a risk of torsion exists if the gastrointestinal stromal tumor develops extramural to lesser curvature and attains a certain size.

Short Bowel Syndrome in neonates and early infancy

Short bowel syndrome (SBS) is the commonest cause of intestinal failure in neonates. SBS results from widespread damage to the small intestine, leading to loss of functional capacity of this organ. This is generally secondary to conditions like necrotizing enterocolitis, gastroschisis, intestinal atresia, and midgut volvulus. The small bowel usually adapts to this damage in due course of time. The clinician's role usually entails the management of parenteral nutrition and the fluid and electrolyte balance to tide over this phase. The management should be initiated as soon as the diagnosis is suspected, especially post-surgical resection of the bowel. This should comprise enteral nutrition, with proactive monitoring and supplementation of electrolytes and micronutrients. Intestinal lengthening procedures like the Serial transverse enteroplasty (STEP), and Longitudinal intestinal lengthening and tailoring (LILT) may be considered in infants, where medical therapy fails to correct the pathology. The intricate nature of the condition warrants a multi-disciplinary approach, involving clinicians, intensivists, and surgeons, which ensures the best neonatal outcomes, in terms of the survival rates in these babies.

Hernia de hiato compleja con vólvulo gástrico asociado

Resumen El vólvulo gástrico es una entidad rara pero potencialmente mortal, donde el estómago sufre una malrotación de todo o parte del mismo alrededor de uno de sus ejes, condicionando una obstrucción del tracto gastrointestinal superior con dilatación gástrica y riesgo de estrangulación. Las complicaciones pueden poner en peligro la vida del paciente, incluidas la necrosis y la perforación. Su diagnóstico suele ser tardío debido a sus síntomas inespecíficos, donde la evaluación de la viabilidad de la mucosa es esencial y la intervención quirúrgica urgente es obligatoria en caso de compromiso vascular.

Volvulus of the Small Intestine in adults with intestinal malrotation: case report

Introduction: The volvulus of the small intestine with intestinal malrotation is a rare disease when occuring in adults, though, a surgeon’s ignorance of this diagnosis can result in potentially fatal extensive small intestinal necrosis. Presentation of case: Here, we present the case of a 57years old woman admitted and operated for a volvulus of the small intestine with intestinal malrotation after radiographic and pre-operative confirmation, whom follow up was unmarked. Discussion: The usual mechanism of obstruction in the volvulus of the small intestine with intestinal malrotation is adhesive compression of the duodenum and volvulus of the small intestine, this condition is the result of an arrest in the normal counterclockwise rotation of the cecum from the left lower quadrant to the right upper quadrant. Pre-operative diagnosis not always an easy task but the abdominal CT-scan is with a great help mainly by identifying the "WHIRL-WIND" sign. The Ladd procedure, consisting of division of Ladd’s bands, widening of the mesentery, and incidental appendectomy, is considered the worldwide standard up til now. Conclusion: This condition is rare and can be diagnosed mainly by CT-scan, however,the surgical management worldwide standard is the Ladd's procedure which can be led by laparotomy or laparoscopy and results in great outcome.

Malrotation and Midgut Volvulus in Children: Diagnostic Approach, Imaging Findings, and Pitfalls

Malrotation and midgut volvulus are surgical emergencies that commonly occur within the first month of life. The classic symptom is acute bilious vomiting, while nonspecific symptoms such as recurrent abdominal pain may be present in older children. Malrotation can be associated with duodenal obstruction caused by an abnormal peritoneal fibrous band or congenital anomalies, such as an annular pancreas or a preduodenal portal vein. Volvulus can lead to bowel ischemia and a life-threatening condition, thus prompt and accurate diagnosis is crucial. Diagnosis can be made through upper gastrointestinal series, ultrasonography, and CT, with ultrasonography being preferred as a screening tool due to its rapid and accurate diagnosis, without radiation exposure, in children. This pictorial essay discusses the key imaging findings and diagnostic approaches for malrotation and midgut volvulus, as well as diagnostic pitfalls based on actual cases.

A Novel Technique of SMA Massage with Systemic Fibrinolytic Therapy in Ischemic Midgut Volvulus: As a Lifesaving Last Expedient.

Midgut volvulus is a surgical emergency requiring immediate intervention. Intestinal ischemia of the midgut as a consequence of volvulus from malrotation is a fateful event with high mortality and significant morbidity even in survivors. Derotation followed by correction of malrotation is the procedure of choice though has significant morbidity if intestinal reperfusion was not successful. A combined treatment to restore intestinal perfusion based on the digital massage of the superior mesenteric artery after derotation and systemic infusion of fibrinolytic has been previously reported with success but underused. Here, we report three such cases of midgut malrotation with severe intestinal ischemia due to volvulus. A retrospective analysis of three confirmed cases of midgut malrotation with volvulus managed with emergency laparotomy, derotation, and Superior Mesenteric Artery (SMA) massage with systemic fibrinolytic therapy, followed by correction of malrotation was evaluated. There was dramatic improvement in intestinal perfusion noted in all three patients inspite of delayed presentation. 2 out of 3 patients on follow up are doing well with adequate weight gain while 1 patient succumbed due to sepsis. Critical intestinal ischemia due to mesenteric thrombosis can persist after derotation of midgut volvulus and can lead to devastating consequences. The use of digital massage of SMA to disrupt the thrombus along with fibrinolytic therapy though reported is underutilized. Hence, awareness of this management and usage needs to be re-emphasized.

Gastric volvulus in elderly patient: a case report, approach and literature review

Background: Acute gastric volvulus is a rare condition that can cause significant morbidity and mortality. The presenting complaint is usually due to symptoms related to gastric outlet obstruction, which might include abdominal pain, nausea and vomiting, bowel obstruction, and even perforation or peritonitis. Case Presentation: A case of acute gastric volvulus was presented in a 78-years-old woman with a complaint of epigastric pain. The patient presented with sudden onset of abdominal pain and vomiting. She was diagnosed with acute gastric volvulus on abdominal imaging and was successfully treated with laparoscopic surgery. Conclusion: This case highlighted the importance of considering gastric volvulus in the differential diagnosis of acute abdominal pain, especially in patients with underlying risk factors.

BRAZILIAN HERNIA AND ABDOMINAL WALL SOCIETY STATEMENT ON LARGE HIATAL HERNIAS MANAGEMENT.

Large hiatal hernias, besides being more prevalent in the elderly, have a different clinical presentation: less reflux, more mechanical symptoms, and a greater possibility of acute, life-threatening complications such as gastric volvulus, ischemia, and visceral mediastinal perforation. Thus, surgical indications are distinct from gastroesophageal reflux disease-related sliding hiatal hernias. Heartburn tends to be less intense, while symptoms of chest pain, cough, discomfort, and tiredness are reported more frequently. Complaints of vomiting and dysphagia may suggest the presence of associated gastric volvulus. Signs of iron deficiency and anemia are found. Surgical indication is still controversial and was previously based on high mortality reported in emergency surgeries for gastric volvulus. Postoperative mortality is especially related to three factors: body mass index above 35, age over 70 years, and the presence of comorbidities. Minimally invasive elective surgery should be offered to symptomatic individuals with good or reasonable performance status, regardless of age group. In asymptomatic and oligosymptomatic patients, besides obviously identifying the patient's desire, a case-by-case analysis of surgical risk factors such as age, obesity, and comorbidities should be taken into consideration. Attention should also be paid to situations with greater technical difficulty and risks of acute migration due to increased abdominal pressure (abdominoplasty, manual labor, spastic diseases). Technical alternatives such as partial fundoplication and anterior gastropexy can be considered. We emphasize the importance of performing surgical procedures in cases of large hiatal hernias in high-volume centers, with experienced surgeons.

Cecal Volvulus with Typical Whirlpool Sign.

Cecal Volvulus with Typical Whirlpool Sign.

A case of congenital diaphragmatic hernia presenting in the adult as gastric volvulus

A case of congenital diaphragmatic hernia presenting in the adult as gastric volvulus

Delayed Presentation of Malrotation: Case Series and Literature Review.

Intestinal malrotation is a congenital anomaly resulting from abnormal or incomplete rotation and fixation of the midgut during embryogenesis. It commonly presents in the neonatal period (75%) with sudden onset bilious vomiting and rarely beyond infancy (<10%). The aim of the study was to highlight the clinical features, radiological findings, and treatment outcomes of patients with malrotation presenting beyond infancy. Eleven consecutive cases of delayed presentation of malrotation presented over a period of 5 years (2017-2021). Data were analyzed retrospectively. Out of the 11 patients, four were female and seven were male. The age of patients ranged from 14 months to 18 years. Patients beyond infancy present usually with diffuse pain abdomen compared to neonates which present with sudden onset bilious vomiting and therefore difficult to diagnose. Five patients had associated abnormalities such as intussusception or nutcracker syndrome or mesenteric cyst or jejunal stricture or mesenteric lymphadenopathy along with malrotation. Patients underwent ultrasonography, upper gastrointestinal contrast study, and contrast-enhanced computed tomography abdomen to confirm the diagnosis. All patients underwent the Ladd procedure with four requiring resection anastomosis and one requiring excision of the mesenteric cyst. Eight out of eleven patients had favorable outcomes, two develop adhesive intestinal obstruction and required re-exploration, and one had persistent complaints of hematochezia. Malrotation beyond infancy is a rare diagnosis. Malrotation in older children is usually not suspected because of the wide range of symptoms. A high index of suspicion on ultrasound or computed tomography is required to demonstrate the reversal of superior mesenteric artery and superior mesenteric vein position and related conditions. Early intervention and treatment can prevent catastrophic events such as intestinal volvulus and intestinal ischemia in these patients.

Gastrointestinal Duplications: A Decade's Experience.

Gastrointestinal (GI) duplications are rare congenital malformations with diverse presentations. They usually present in the pediatric age, especially in the first 2 years of life. To present our experience with GI duplication (cysts) at a pediatric surgery tertiary care teaching institute. It is a retrospective observational study undertaken in the department of pediatric surgery at our center between 2012 and 2022 for GI duplications. All children were analyzed for their age, sex, presentation, radiological evaluation, operative management, and outcomes. Thirty-two patients were diagnosed with GI duplication. Slight male predominance was present in the series (M: F ≈ 4:3). Fifteen (46.88%) patients presented in the neonatal age group; 26 (81.25%) patients were under 2 years. In the majority of cases (n = 23, 71.88%), the presentation was acute onset. Double duplication cysts on opposite sides of the diaphragm were present in one case. The most common location was ileum (n = 17), followed by gallbladder (n = 6), appendix (n = 3), gastric (n = 1), jejunum (n = 1), esophagus (n = 1), ileocecal junction (n = 1), duodenum (n = 1), sigmoid (n = 1), and anal canal (n = 1). Multiple associations (malformations/surgical pathologies) were present. Intussusception (n = 6) was the most common, followed by intestinal atresia (n = 5), anorectal malformation (n = 3), abdominal wall defect (n = 3), hemorrhagic cyst (n = 1), Meckel's diverticulum (n = 1), and sacrococcygeal teratoma (n = 1). Four cases were associated with intestinal volvulus, three cases with intestinal adhesions, and two with intestinal perforation. Favorable outcomes were present in 75% of cases. GI duplications have varied presentations depending on site, size, type, local mass effect, mucosal pattern, and associated complications. The importance of clinical suspicion and radiology cannot be underrated. Early diagnosis is required to prevent postoperative complications. Management is individualized as per the type of duplication anomaly and its relation with the involved GI tract.