Volvulus Of Small Intestine Research Articles

Long-term survival and complications following small intestinal resection and partially stapled, functional end-to-end anastomosis.

The aim of the present study was to investigate the long-term survival and postoperative complications in horses that had undergone small intestinal resection and a modified anastomosis technique using a partially stapled, functional end-to-end anastomosis. Observational retrospective case series. A total of 25 horses underwent small intestinal resection and a partially stapled, functional end-to-end anastomosis. A modified technique to create a partially stapled, functional end-to-end anastomosis is described. The clinical case records of all horses that fulfilled the criteria between January 1, 2010 and January 1, 2020 were reviewed. Data on short-term survival and postoperative complications were collated. A telephone questionnaire of owners was undertaken to evaluate long-term survival. Duration of follow up was from one to 4232 days (median 785 days). A total of 21/25 (84%) of horses survived to discharge, 19/25 (76%) horses were alive at 6 and 12 months and 64% survived to 2 years. A total of 64% of horses developed at least one postoperative complication. Two horses developed a small intestinal volvulus necessitating repeat laparotomy. One horse had kinking at the anastomosis site diagnosed at post-mortem examination. Partially stapled functional end-to-end anastomosis technique in this study had similar short- and long-term survival to those reported in previous studies using handsewn techniques, but severe complications at the anastomosis site occurred in >10% of cases. The anastomosis technique described appears to have similar short- and long-term survival and complication rates, compared to more commonly used anastomosis techniques. However, there is potential for severe complications at the anastomosis site.

Multiple endocrine neoplasia type 2B diagnosed after small intestinal volvulus with progressive megacolon in an adolescent

Multiple endocrine neoplasia type 2B is a rare autosomal dominant disease characterized by the presence of medullary thyroid carcinoma, pheochromocytoma, Marfan-like fatigue, a peculiar face with thickening of the lips, mucosal neuromas on the lips and tongue, and gastrointestinal phenomena. Most patients harbor pathological variants of the RET gene. Herein, we present the first case of a 14 year-old boy who experienced small intestinal volvulus along with a megacolon, and he was diagnosed with multiple endocrine neoplasia type 2B. The patient complained of constipation since he was 2 years old and slowly progressive abdominal distension at school age. At 14 years of age, he presented with remarkable megacolon mimicking Hirschsprung’s disease and complicated with small intestinal volvulus. The volvulus was successfully repaired, and the particularly dilated transverse colon was resected following a rectal biopsy. Histopathological evaluation of the resected transverse colon revealed to be compatible with ganglioneuromatosis. After emergency surgery, the patient was diagnosed with multiple endocrine neoplasia type 2B with medullary thyroid carcinoma, and a de novo variant of RET was confirmed. Gastroenterologists should consider it when treating patients with constipation, especially those with megacolon. Therefore, timely diagnosis may lead to appropriate treatment of medullary thyroid carcinoma and improve mortality.

A Complete Common Mesentery Presenting With Appendicular Peritonitis : Case report

Intestinal malrotation is an uncommon anomaly resulting from an interruption in the rotation and fixation of the embryonic gut. It can remain asymptomatic if the rotation halts at 90 degrees, leading to atypical presentations such as appendicitis, as observed in our case, or pose serious risks when accompanied by incomplete common mesentery and compounded by small intestine volvulus. A 58-year-old male presented with abdominal pain four days prior to admission, accompanied by fever. Clinical examination revealed abdominal tenderness, and laboratory tests indicated an inflammatory response. A CT scan confirmed acute appendicitis associated with complete common mesentery, prompting the patient to undergo open laparotomy appendectomy. Despite acute appendicitis typically presenting in a conventional manner, diagnosing its atypical forms in the context of intestinal malrotation poses considerable challenges. Abdominopelvic CT scan plays a crucial role in diagnosis, and laparoscopic appendectomy is the preferred treatment approach.

Enteric glial cell network function is required for epithelial barrier restitution following intestinal ischemic injury in the early postnatal period.

Ischemic damage to the intestinal epithelial barrier, such as in necrotizing enterocolitis or small intestinal volvulus, is associated with higher mortality rates in younger patients. We have recently reported a powerful pig model to investigate these age-dependent outcomes in which mucosal barrier restitution is strikingly absent in neonates but can be rescued by direct application of homogenized mucosa from older, juvenile pigs by a yet-undefined mechanism. Within the mucosa, a postnatally developing network of enteric glial cells (EGCs) is gaining recognition as a key regulator of the mucosal barrier. Therefore, we hypothesized that the developing EGC network may play an important role in coordinating intestinal barrier repair in neonates. Neonatal and juvenile jejunal mucosa recovering from surgically induced intestinal ischemia was visualized by scanning electron microscopy and the transcriptomic phenotypes were assessed by bulk RNA sequencing. EGC network density and glial activity were examined by Gene Set Enrichment Analysis, three-dimensional (3-D) volume imaging, and Western blot and its function in regulating epithelial restitution was assessed ex vivo in Ussing chamber using the glia-specific inhibitor fluoroacetate (FA), and in vitro by coculture assay. Here we refine and elaborate our translational model, confirming a neonatal phenotype characterized by a complete lack of coordinated reparative signaling in the mucosal microenvironment. Furthermore, we report important evidence that the subepithelial EGC network changes significantly over the early postnatal period and demonstrate that the proximity of a specific functional population of EGC to wounded intestinal epithelium contributes to intestinal barrier restitution following ischemic injury.NEW & NOTEWORTHY This study refines a powerful translational pig model, defining an age-dependent relationship between enteric glia and the intestinal epithelium during intestinal ischemic injury and confirming an important role for enteric glial cell (EGC) activity in driving mucosal barrier restitution. This study suggests that targeting the enteric glial network could lead to novel interventions to improve recovery from intestinal injury in neonatal patients.

Clinical findings, surgical techniques, prognostic factors for short-term survival and long-term outcome in horses with acquired inguinal hernias: Ninety-eight cases (2005-2020).

To report findings, outcome and determine variables associated with survival in horses with acquired inguinal hernia (AIH). Retrospective study. A total of 98 cases in 97 horses. The medical records (2005-2020) of horses diagnosed with AIH were reviewed. Retrieved data included signalment, history, clinical variables, surgical aspects, postoperative complications, and short- and long-term outcomes. Logistic regression analyses were used to determine factors associated with short-term survival (p < .05). Manual reduction was attempted in a third of the cases (32/98, 33%) and emergency surgery to reduce the hernia was performed in 64 of 98 (65%) cases. Concurrent small intestinal (SI) volvulus was identified in 26 (26/98, 27%) cases. Castration was the most common technique used to prevent recurrence (64/94, 68%). Overall AIH recurrence rate was 11% (11/98). A total of 59 (59/98, 60%) cases survived to hospital discharge and 49 of 52 (94%) cases were still alive after 12 months. Cases admitted within 10 h of colic signs had increased odds of survival (72%) compared to those admitted after 10 h (26%; p < .001). Draft breeds (p = .021), high heart rate on admission (p = .001) and concurrent SI volvulus (p = .048) were associated with reduced survival to hospital discharge. Horses with AIH had a higher risk of concurrent SI volvulus and lower survival than reported. Draft breeds, high heart rate on admission and concurrent SI volvulus were associated with reduced short-term survival. The results of this study should help in prognostication for horses with AIH.

An Unexpected Cause of Sudden Death Reported as a Case of Adverse Event Following Immunization (AEFI)

Adverse event following immunization is any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine. Here we had a case where a 20-year-old male, who had taken second dose of Covishield vaccine and presented with complaints of fever, vomiting and abdominal pain. He was managed conservatively, but he collapsed and died at home, the next day. Autopsy revealed it as a case of small bowel volvulus with complications like gangrene and peritonitis. Volvulus of small intestine is a rare condition; non-specific clinical features and laboratory investigations make it difficult to diagnose. Coincidence with vaccination perhaps complicated the diagnosis in this case, which needed to be dealt as a surgical emergency.

Entrapment of a jejunocecostomy anastomosis in the epiploic foramen in a horse

A mare aged 9 years underwent surgical correction of a small intestinal volvulus using a side-to-side, hand-sewn jejunocecal anastomosis. Nine months after the jejunocecostomy, the horse developed colic signs and ultrasonographic examination revealed gas in the large colon in the upper right flank region and several enlarged loops of the small intestine in the lower right flank area. The differential diagnosis was right dorsal displacement of the large colon or small intestinal strangulation. The exploratory celiotomy found epiploic foramen entrapment (EFE) of the jejunocecostomy anastomosis, including parts of the distal jejunum and cecum. Manual reduction of herniation of the bowel in the epiploic foramen (EF) was impossible and the horse was euthanized. The postmortem gross finding revealed the enlarged edematous at the distal end of the jejunum and the initial body portion of the cecum had passed into the EF in the right-to-left (antegrade) direction. To the authors’knowledge, this is the first report of the antegrade epiploic foramen entrapment of a jejunocecostomy bowel part and this may be one of the complications encountered during the long-term survival period of a surgical jejunocecostomy in horses.

Small Bowel Volvulus: A Rare Case Report

Adult small intestinal volvulus is a rare entity and even more rarely, the ileum undergoes torsion without known predisposing factors. This presents as an acute abdomen. Although a rare condition, it should be kept in mind in cases of abdominal pain with or without intestinal obstruction. Since there is no specific laboratory or routine radiological finding in these cases, a CT scan abdomen is the investigation of choice. Small intestinal volvulus exits as two types according to etiology. Emergency surgical intervention is the treatment of choice. Delay and missed diagnosis have serious consequences with increased morbidity and mortality due to bowel ischemia. Here we report a case of a 32-year-old male having no predisposing factors presenting with abdominal pain, nausea, and vomiting. Physical examination and investigations were unremarkable. The patient was managed by urgent surgical intervention after having confirmed the diagnosis peroperatively as small bowel volvulus. Keywords: Abdominal pain, Small bowel volvulus, Intestinal obstruction, Midgut volvulus, Bowel necrosis, Whirlpool sign.

Epidemiology and causes of intestinal obstruction in Ethiopia: A systematic review.

Objective:This systematic review was aimed to address the prevalence and causes of intestinal obstruction in Ethiopia.Methods:Systematic searches were conducted on PubMed, EMBASE, CINAHL, Scopus, African Journals Online, HINARI, and other supplementary sources, including Google Scholar. We conducted methodological quality assessments for the articles by employing a critical appraisal checklist of Joanna Briggs Institute.Results:The reported prevalence of intestinal obstruction in Ethiopia ranges from 18.6% to 50.7% among patients with acute abdomen. However, the prevalence varies from 4.3% to 34.6% among total surgical admissions. The leading causes of small intestinal obstruction were small bowel volvulus, intussusception, and adhesion. Sigmoid volvulus was the most commonly reported cause of large intestine obstruction, followed by colonic cancer.Conclusion:The highest reported prevalence of intestinal obstruction in Ethiopia was 50.7% among patients with acute abdomen and 34.6% among surgical admissions. Small intestine volvulus and sigmoid volvulus were the common causes of small and large bowel obstructions, respectively. Therefore, clinicians have to consider the common causes during the diagnosis and management of intestinal obstruction.

Non-Operatively Managed Primary Small Bowel Volvulus: A Case Report

Background: Primary small intestinal volvulus is one of the common causes of intestinal obstruction in various localities of the developing world. Although operative intervention has been the usual mode of treatment; this case report depicts with meticulous follow-up & care, there is a possibility for relief of obstruction with non-operative management.

Back Propagation Neural Network-Based Magnetic Resonance Imaging Image Features in Treating Intestinal Obstruction in Digestive Tract Diseases with Chengqi Decoction

This study was to explore the adoption effect of magnetic resonance imaging (MRI) image features based on back propagation neural network (BPNN) in evaluating the curative effect of Chengqi Decoction (CD) for intestinal obstruction (ileus), so as to evaluate the clinical adoption value of this algorithm. Ninety patients with ileus were recruited, and the patients were treated with CD and underwent MRI scans of the lower abdomen. A BPNN model was fabricated and applied to segment the MRI images of patients and identify the lesion. As a result, when the overlap step was 16 and the block size was 32 × 32, the running time of the BPNN algorithm was the shortest. The segmentation accuracy was the highest if there were two hidden layer (HL) nodes, reaching 97.3%. The recognition rates of small intestinal stromal tumor (SIST), colon cancer, adhesive ileus, and volvulus of MRI images segmented by the algorithm were 91.5%, 88.33%, 90.3%, and 88.9%, respectively, which were greatly superior to those of manual interpretation (P < 0.05). After the intervention of CD, the percentages of patients with ileus that were cured, markedly effective, effective, and ineffective were 65.38%, 23.16%, 5.38%, and 6.08%, respectively. The cure rate after intervention of CD (65.38%) was much higher in contrast to that before intervention (13.25%) (P < 0.05). In short, CD showed a good therapeutic effect on ileus and can effectively improve the prognosis of patients. In addition, MRI images based on BPNN showed a good diagnostic effect on ileus, and it was worth applying to clinical diagnosis.

Non‐surgical manual reduction of indirect inguinal hernias in 89 adult stallions

SummaryBackgroundIndirect inguinal hernia (IIH) is the most commonly reported acquired hernia in adult horses. Outcomes following surgical intervention comprising of immediate ventral midline laparotomy (IVML) and simultaneous castration are well known. The outcome following reduction of IIH utilising a noninvasive manual reduction (MR) technique in a large number of horses has not been previously reported.ObjectivesTo describe a nonsurgical MR technique developed by the authors and to report our long‐term experiences and clinical outcome.Study designRetrospective study.MethodsMedical records of 89 stallions presenting with IIH and treated with MR were reviewed. Extensive patient data was collected, with cases grouped based on outcome of the MR procedure and whether or not laparotomy was performed. Data on short‐ and long‐term outcome was obtained.ResultsManual reduction was successful in 80 of 89 (90%) horses. Fifty of 89 (56%) horses were treated with MR only and without exploratory laparotomy. In total 29 of 89 (33%) horses underwent IVML and 10 of 89 (11%) delayed ventral midline laparotomy (DVML). Resections were performed in 6 of 89 (8%) horses. Concurrent small intestinal volvulus was diagnosed in 8 of 89 (9%) horses. Horses undergoing DVML following a successful MR had the highest mortality rates during hospitalisation (4/10, 40%). Short‐term survival was 92% (82/89). Ipsilateral reoccurrence of IIH post‐hospital discharge was recorded in 7 of 47 (15%) horses. Overall long‐term survival with a median of 12 years was 72% (34/47).Main limitationsThese include the retrospective nature of data collection, lack of standardised pre‐ and post‐MR clinical assessments and a biased Warmblood population.ConclusionsManual reduction appears to be a feasible nonsurgical technique to reduce IIH in adult Warmblood horses, with favourable survival rates. Individual case assessment is crucial, as delayed laparotomy may increase mortality rates. Suspicion of concurrent small intestinal volvulus or devitalised small intestine always warrants immediate laparotomy following MR.

A retrospective study of gastrointestinal disorders in a predominantly Austrian leisure horse referral hospital population

SummaryThe aim of our retrospective study was to produce and analyse epidemiological data on gastrointestinal (GI) disorders of Austrian leisure horses. Case records of horses referred to the Equine Clinic of the Veterinary University of Vienna were collected from an electronic hospital information system using its search options. All cases reported to have suffered a GI disorder between March 2003 and February 2015 were selected. In this period of 4314 days, data of 1833 GI cases, mostly accompanied by colic signs, were analysed. The vast majority of our GI cases appeared in the abdominal parts of the GI tract 96% (1760/1833) while just 1.3% (24/1833) could be definitively attributed to oesophageal disorders, whereas in 2.7% (49/1833) of the cases a definitive diagnosis could not be made. The highest prevalence of GI disorders was seen in July and October/November. A breakdown of figures for cases clustered under the colic syndrome showed that colon impactions in left ventral large and/or pelvic flexure (35%) were the major problem followed by gastric disorders (18%), spasmodic colic (9%), enteritis (7%), caecal tympany (6%); caecal impaction (4%), colitis (3%), abnormal anatomical positions of large colon including complete and partial strangulation/volvulus, nephrosplenic entrapment of the left ventral and dorsal colon and right dorsal displacement of the large colon (3%) and small intestinal volvulus (2.7%). In 12% of the cases, the cause of the abdominal discomfort was likely idiopathic paralytic ileus. The searching tool of the electronic patient data also brought up cases with malabsorbtion/IBD syndrome and GI ruptures, both these contributed less than 1% of the referred GI cases. Results suggested that the causes of colic are diverse, but the major reasons for referred cases of colic in the east Austrian horse population are large colon impaction or displacements. Seasonal distribution and specific causes of gastrointestinal disorders should be considered essential components of the initial clinical assessment of horses presenting with colic.

Caecal volvulus and jejunostomy: challenging diagnostic

Caecal volvulus represent the 20–40% of colonic volvulus, being the second most frequent localization. It causes intestinal occlusion symptomatology (nausea, vomiting, abdominal distension). We present a case of 45-year-old women with feeding jejunostomy tube due to connatal anoxia. She arrives at A&E after 12 h of vomits and abdominal pain. The CT scan shows a small intestine dilation that suggested a small intestine volvulus. A laparotomy is performed showing a caecal volvulus, so ileo-cequectomy with primary anastomosis is performed. After several complications, she was discharged after 60 days of hospital stay. Caecal volvulus can be challenging to diagnose by clinic, because it can be hardly differenced from other intestinal occlusion causes. CT scan can be useful to reach the diagnostic and see signs of tissue suffering. In contrast with sigma volvulus, endoscopic treatment has not shown any benefit to solve it.

Small intestinal volvulus and colonic rupture in a dog after gastric dilation and volvulus

AbstractAn adult Standard Poodle was presented with gastric dilation and volvulus (GDV). An emergency laparotomy was performed, during which the stomach was derotated and an incisional gastropexy was performed. The dog recovered uneventfully from surgery and was stable for two days. Three days postoperatively, his condition declined markedly. Evidence of peritonitis was found on abdominal ultrasound, with no clearly identified underlying cause. The dog was euthanased and underwent gross postmortem examination. A small intestinal volvulus and macroscopic evidence of strangulation of a section of colon transversum with intestinal perforation was found. There were no lesions identified associated with the stomach or gastropexy site. This case report discusses possible reasons for the development of the intestinal volvulus and the strangulation and rupture of the colon in a dog after GDV surgery.

Antenatal predictors of intestinal pathologies in fetal bowel dilatation.

Fetal bowel dilatation (FBD) in the late trimester of pregnancy can be related with varies of prognosis. Our aims were to obtain antenatal factors that might have relevance for the distinct prognosis with FBD. Seven features of 68 pregnancies presented with FBD were assessed. The best cut-off value to predict intestinal outcomes was selected using receiver-operating characteristics curves, and the effective variables were included into a logistic regression model. The best cut-off valves to predict intestinal pathologies were 14.5 mm of fetus dilated loop and 37.7 weeks of gestational age at delivery, respectively. The congenital gastrointestinal tract anomalies included 24 cases (92.3%) of intestine atresia, 1 case (3.85%) of small intestine volvulus and 1 case (3.85%) of midgut malrotation. Fetal dilated loops and gestational age at delivery are both an independent risk factor for predicting intestinal pathologies of newborns, which should arouse high attention.

Appendiceal mucinous cystadenoma presenting as abdominal internal hernia: a case report

Appendiceal mucinous neoplasm is a rare form of appendix disorder of all appendectomies. Patients may present with many non-special symptoms which the right low quadrant pain is the mostly reported. We reported a case of 70-year-old man who was admitted to emergency for abdominal pain and progressive aggravation of peritoneal irritation sign. Computed tomography (CT) revealed incomplete intestinal obstruction with volvulus of partial small intestine in right lower quadrant, and internal hernia was suspected and simple appendectomy was performed followed. The postoperative pathologic diagnosis was mucinous cystadenoma with negative cutting margin. During three-year follow-up, the patient was in good condition and there was no sign of recurrence.

Prognostic value of preoperative plasma l-lactate concentrations in calves with acute abdominal emergencies

Acute abdominal emergencies in calves due to abomasal disorders, gastrointestinal ileus, or peritonitis are characterized by a rapid disease progression and usually require immediate surgical intervention. Those conditions are associated with a guarded prognosis, and the aim of the present study was to assess the prognostic relevance of preoperatively measured plasma l-lactate concentrations (l-LAC) in a large study population of calves with a broad spectrum of acute abdominal emergencies. For the purpose of this study, the medical records of 587 calves admitted to a veterinary teaching hospital over a 10-yr period were analyzed retrospectively. Plasma l-LAC was measured as part of a routinely performed biochemistry panel before initiation of surgical intervention. Hyper-l-lactatemia (plasma l-LAC >2.2 mmol/L) was evident in 75% of calves, and the overall survival rate until hospital discharge was 31%. Calves with a negative outcome were younger (median: 3.4 vs. 6 wk) and had higher plasma l-LAC (median: 4.96 vs. 3.09 mmol/L) than calves with a positive outcome. At the individual diagnosis level, l-LAC was associated with mortality in calves with a diagnosis of mesenteric torsion, right-sided dilated abomasum, small intestinal volvulus, or paralytic ileus, but not in calves suffering from peritonitis, malformations, abomasal volvulus, bloat, or small intestinal intussusceptions. Considering the whole study population, the area under the receiver operating characteristic (ROC) curve for plasma l-LAC was 0.66 [95% confidence interval (CI): 0.61-0.70]. A classification tree analysis indicated that l-LAC >8.84 mmol/L and age categories of <3 wk and <1 wk were independent predictors of mortality. The area under the ROC curve of this model was 0.75 (95% CI: 0.71-0.79) and the resulting sensitivity and specificity for the prediction of nonsurvival at the optimal probability cut-point of 0.62 were 67.7 and 76.6%, respectively. In conclusion, hyper-l-lactatemia is common in calves suffering from acute abdominal emergencies. Markedly increased plasma l-LAC is associated with an increased mortality risk, but it is not possible to reliably predict the outcome of affected calves based on a single, preoperative measurement. However, a clinically important finding of this study was that the ability to predict a negative outcome is improved when the age of the calf is considered in addition to plasma l-LAC.

Non-transplant Surgical Management of Short Bowel Syndrome in Children: An Overview.

Management of severe Short Bowel Syndrome (SBS) is still one of the largest challenges of the medicine. Vast majority of the short bowel patients are children, the conditions that lead to this possible outcome most often are necrotizing enterocolitis (NEC), small intestinal volvulus as a result of intestinal malrotation, gastroschisis and the "apple peel" syndrome. Therefore, paediatricians and paediatric surgeons face this challenge most often. The nontransplant treatment appears to be effective using surgical procedure to increase absorptive surface and to reduce the transit time, but in some cases these procedures are enough to weaning of TPN. The aim of this review was to summarize the modern non-stransplant surgical management of short bowel syndrome.

Gastrointestinal motility should be emphasized after laparotomy treatment for complete small intestinal volvulus in older adults

Rationale:Complete small intestinal volvulus is a rare entity in adults, unlike partial intestinal volvulus. Although prompt surgical intervention is the mainstay of treatment, attention should also be paid to recovery of intestinal function postoperatively. Ignoring this issue during the postoperative recovery process can have serious consequences. We report the case of an 82-year-old woman with complete small intestinal volvulus at the root of the superior mesenteric vessel.Patients concerns:The patient was admitted for acute onset (22 hours) of abdominal pain and distention. Nausea and vomiting also developed during this period.Diagnoses:Abdominal physical examination was suspicious for peritoneal irritation. Computed tomography scan showed anticlockwise swirl of the mesenteric vessels at the lower margin of the pancreas with distension of the entire small intestine. A complete small intestinal volvulus was diagnosed.Interventions:Laparotomy and detorsion of the volvulus were performed after early diagnosis.Outcomes:The patient developed intestinal wall edema because of ischemic–reperfusion damage. She exhibited severe abdominal distention and absent intestinal motility. Two days later, she went into septic shock; she died 19 days after surgical intervention.Lessons:Because complete small intestinal volvulus involves the entire intestine, ischemic–reperfusion intestinal damage after detorsion may be severe and can predict prognosis.