An 11-year-old Trakehner gelding required 2 ventral midline celiotomies for correction of a large colon volvulus and a large colon displacement, respectively. Laparoscopic colopexy was performed 50 days following the 2nd celiotomy. Delayed laparoscopic colopexy is minimally invasive and does not disrupt the ventral midline incision following abdominal exploration. (+info)
Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process.
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BACKGROUND/AIMS: The sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus. METHODOLOGY: We present our experience of 81 cases of sigmoid volvulus admitted to our department. RESULTS: Preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann's pouch. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus. CONCLUSIONS: Initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process. (+info)
Observations on the pattern of vomiting and morbidity in patients with acute sigmoid volvulus.
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BACKGROUND: Vomiting is usually a late and an infrequent symptom of colonic obstructions. Contrary to this general rule, it occurs early and more frequently in some cases of sigmoid volvulus. AIM: To study the clinical significance of vomiting in patients with sigmoid volvulus. SETTING: Teaching hospital in Western Orissa, India STUDY DESIGN: Prospective observational study MATERIAL AND METHODS: Prospectively enrolled subjects with sigmoid volvulus diagnosed on the basis of clinical, radiological and laparotomy evidence were included in the study carried out in a tertiary care centre in India. Detailed history was obtained from them, especially to elicit information about the occurrence of various symptoms. Information regarding type of vomiting was also obtained. Efforts were made to exclude other causes of vomiting. Statistical tests such as Chi-Square test, Fisher's exact test or Student's t test were used. RESULTS: Ninety-three consecutive subjects with sigmoid volvulus were enrolled. Five patients with possible other aetiologies for vomiting and seven patients with compound sigmoid volvulus were eliminated from further analysis. Two patterns of vomiting were noted in 81 evaluable patients with sigmoid volvulus. In 33 patients (Group A), vomiting preceded or coincided with the onset of other abdominal symptoms (Type 1 vomiting). In 48 patients (Group B) vomiting occurred after the onset of other abdominal symptoms (Type 2 vomiting). The period between the onset of these symptoms and that of vomiting varied from a few hours to several days. Group A patients sought medical help much earlier than those of Group B. Incidences of circulatory shock (24% vs. 8%), haemorrhagic ascites (21% vs. 6%) and colonic gangrene (64% vs. 35%) were significantly higher in Group A than in Group B. The mortality rate (15% vs. 4%) was higher in Group A as well. About 25% (n = 7) of Group A patients in contrast to 4% (n=2) of Group B required hospitalization exceeding 3 weeks. Vomitus was predominantly non-bilious (21 out of 33 patients) in Group A (64%) and bilious (10 out of 11 patients) in Group B (91%). CONCLUSION: Type 1 vomiting appears to be an indicator of more severe presentation and is associated with an increased morbidity and mortality. This study suggests that the pattern of vomiting could be a simple and useful predictor of prognosis in sigmoid volvulus. (+info)
Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations.
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OBJECTIVE: To illustrate cases of midgut volvulus in 7 children, of whom only 2 were neonates, diagnosed initially by sonography using the whirlpool sign, and to emphasize the importance of considering malrotation and midgut volvulus in the differential diagnosis of acute or chronic abdominal pain in those beyond the neonatal period, the usual time of presentation for midgut volvulus. METHODS: The sonography computer database of a large pediatric hospital was reviewed over a 26-month period for sonographic reports that contained the key words midgut volvulus and whirlpool sign. From November 1999 until January 2002, 7 patients had a sonographic diagnosis of midgut volvulus on the basis of the whirlpool sign. Sonographic and surgical records of these patients were reviewed retrospectively. In addition, the department computer database of all contrast-enhanced upper gastrointestinal examinations performed over the same period was searched using the key words midgut volvulus, and an additional 2 cases of midgut volvulus were found, neither of which had undergone a prior or subsequent sonographic study. RESULTS: Seven patients, ranging in age from 1 day to 5 1/2 years were found to have the whirlpool sign on sonography performed for acute abdominal symptoms, including projectile nonbilious emesis, colicky abdominal pain with suspicion of intussusception, palpable abdominal masses, right lower quadrant abdominal pain with suspected appendicitis, and chronic diarrhea. Six of the 7 cases of midgut volvulus were confirmed with upper gastrointestinal examinations. One patient was taken directly to surgery on the basis of the sonographic findings alone. One patient had subsequent computed tomography of the abdomen for continued suspicion of an abdominal mass. All 7 cases were confirmed as midgut volvulus at surgery. CONCLUSIONS: The sonographic whirlpool sign is a valid and highly sensitive sign for the diagnosis of midgut volvulus secondary to malrotation, and sonographers should be aware that it frequently occurs beyond the neonatal period with symptoms other than bilious emesis. (+info)
Detection and comparison of nitric oxide in clinically healthy horses and those with naturally acquired strangulating large colon volvulus.
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The objective of the study was to determine whether nitric oxide (NO) is present in clinically healthy horses (control) under basal conditions, and if it increases secondary to naturally acquired strangulating large colon volvulus (affected). Eleven affected horses and 10 controls were studied. Jugular venous blood, abdominal fluid, and urine were collected. The NO concentrations were standardized to the creatinine concentration in the respective samples. A biopsy specimen collected from the large colon pelvic flexure at surgery was divided into subsections for processing for inducible nitric synthase (iNOS) and nitrotyrosine (NT) immunohistochemical staining and reduced nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemical staining. There were no significant differences in plasma, abdominal fluid, or urine NO concentrations between affected and control horses. There was a significant decrease in submucosal arteriolar and venular endothelium, submucosal plexus, mucosal leukocyte, mucosal and musclaris vasculature, and myenteric plexus NADPH diaphorase staining in affected versus control horses. There was a significant increase in iNOS staining in mucosal leukocytes and vasculature in affected versus control horses. Other than a greater number of positively stained mucosal leukocytes in affected horses, there were no significant differences between affected and control horses for NT staining. The presence of NADPH diaphorase staining in the endothelium and submucosal neurons suggests endothelial and neuronal NOS are present under basal conditions in the large colon of horses. Increased iNOS and NT staining in mucosal leukocytes of affected horses suggests involvement of the NO pathway in large colon volvulus. The reasons for the lack of a significant difference in plasma, abdominal fluid, and urine NO concentrations between affected and control horses are unknown. (+info)
Sigmoid volvulus complicating pregnancy.
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Sigmoid volvulus complicating pregnancy is an extremely rare complication with fewer than 76 cases reported in literature. We report a case of sigmoid volvulus complicating pregnancy. The sigmoid colon was resected and Hartman's colostomy was performed. The patient had a successful recovery. Aggressive resuscitation followed by early surgical intervention should be undertaken to reduce maternal and fetal morbidity and mortality. (+info)
Cecocolic torsion: classification, pathogenesis, and treatment.
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Cecocolic torsion is a class of right colon obstruction. Under this heading, the known and the recently identified variants are unified under 1 classification. An algorithm is utilized to trace the pathogenesis of these variants. Recent data, prevailing definitions, and controversies are discussed and resolved. The significance of specific membranes and the blood supply is clarified. New symptoms, clinical and x-ray diagnoses are elucidated. The recommended treatments are outlined. (+info)
Clinics in diagnostic imaging (105): Sigmoid volvulus causing intestinal obstruction, with successful endoscopic decompression.
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An 89-year-old woman was admitted for intestinal obstruction. Her abdominal radiograph showed typical features of sigmoid volvulus. Decompression was done successfully through careful flexible sigmoidoscopy with minimum air insufflation. The patient's symptoms were relieved and she was discharged two days post-procedure. No recurrence was noted at extended follow-up. Rapid diagnosis and early decompression are key to optimal management of sigmoid volvulus. (+info)