Ileocecal valve atresia with volvulus

Abstract Background Meckel’s diverticulum is considered the most prevalent congenital anomaly of the gastrointestinal tract. Approximately 4% of patients are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation, while axial torsion of Meckel’s diverticulum is rare, particularly in pregnancy. Case presentation A 31-year-old woman in week 15 of pregnancy complained of epigastric pain, nausea and vomiting. Clinical diagnosis was severe hyperemesis gravidarum. Because the symptoms persisted during hospitalization, CT was performed and revealed dilated small bowel loops with multiple air-fluid levels. In the right mid-abdomen, there was a large part of air containing a cavity connected to the small intestine, which was considered a dilated bowel loop. Emergency laparotomy was performed and axial torsion of a large Meckel’s diverticulum measuring 11 cm was found at a few centimeters proximal to the ileocecal valve. Ileocecal resection including Meckel’s diverticulum was performed. The postoperative course was uneventful. At 40 weeks gestation, she had vaginal delivery of normal baby. Conclusion The physiological and anatomical changes in pregnancy can make a straightforward clinical diagnosis difficult. Prompt diagnosis and management were needed in order to avoid significant maternal and fetal risks. The use of imaging examinations, especially CT examination, with proper timing may be helpful to prevent delay in diagnosis and surgical intervention. Here, we report the case of a patient with axial torsion of Meckel’s diverticulum in pregnancy. To our knowledge, axial torsion of Meckel’s diverticulum in the first trimester of pregnancy has not been reported in the English medical literature.

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Challenge in diagnosis of late onset necrotizing enterocolitis in a term infant: a case report

BMC Pediatrics ◽

10.1186/s12887-021-02626-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gunadi ◽

Dian Nirmala Sirait ◽

Aditya Rifqi Fauzi ◽

Ninditya Nugroho ◽

Fadil Fahri ◽

...

Keyword(s):

Ct Scan ◽

Necrotizing Enterocolitis ◽

Intestinal Inflammation ◽

Late Onset ◽

Gastrointestinal Disease ◽

Early Recognition ◽

Ileocecal Valve ◽

Abdominal Distention ◽

Clinical Deterioration ◽

Wall Thickening

Abstract Background Necrotizing enterocolitis (NEC) is a common devastating inflammatory gastrointestinal disease and frequently occurs in premature infants. Here, we reported a case of late-onset NEC in a term neonate with good outcome after surgery for long-term follow-up. Case presentation Ten-week-old male came to emergency unit due to prolonged diarrhea and abdominal distention. He was born at gestational age of 40 weeks with birth weight and Apgar score of 2800 g and 7/8, respectively. He had no history of formula feeding. Two weeks before admitted to the hospital, the patient had frequent diarrhea with fever. He was found lethargic with abdominal distention, absence of bowel sounds and abdominal tenderness. Plain abdominal x-ray and CT scan showed gastric and intestinal dilatation and gasless colon, suggesting a small bowel obstruction, and bowel wall thickening indicating peritonitis, without any free subdiaphragmatic air (pneumoperitoneum). Moreover, the patient did not have a congenital heart disease. While in intensive medical treatment, he showed a continuous clinical deterioration. All findings were suggestive of intestinal inflammation with clinical deterioration, and we decided to perform an emergency exploratory laparotomy and found an ischemia along the jejunoileal with a perforation at 25 cm above the ileocecal valve. Subsequently, we performed a double-barrel ileostomy through a separate incision from the laparotomy. Histopathological findings confirmed the diagnosis of NEC. We closed the stoma at postoperative day 43. The patient was discharged uneventfully a month after stoma closure. Conclusion Abdominal CT scan might be useful to establish an early recognition of late-onset NEC; thus, immediate surgical intervention might be performed to decrease its morbidity and mortality. Moreover, late-onset NEC in term neonates might occur without any risk factors or significant co-morbidities.

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Nutrient and bowel segment dependency of human intestinal control of gastric secretion

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1982.243.5.g372 ◽

1982 ◽

Vol 243 (5) ◽

pp. G372-G376

Author(s):

C. Owyang ◽

L. J. Miller ◽

J. R. Malagelada ◽

V. L. Go

Keyword(s):

Small Bowel ◽

Acid Secretion ◽

Control Level ◽

Amino Nitrogen ◽

Ileocecal Valve ◽

Essential Amino Acids ◽

Distal Segment ◽

Nutrient Loads ◽

Inhibited Acid ◽

Different Levels

The gastric secretory effects of protein, fat, and carbohydrate infused at different levels of the small bowel were investigated in seven healthy subjects. Similar caloric loads (53.4 kcal) of protein (essential amino acids), lipid (oleic acid), and carbohydrate (glucose) in isomolar (280 mosmol/l) similar pH (7.4) solutions were infused into 60-cm segments of small bowel (isolated between two occlusive balloons), located distal to the ligament of Treitz (proximal), proximal to the ileocecal valve (distal), and between the two (middle). A submaximal gastric secretory background was provided by continuous intravenous pentagastrin. Protein stimulated acid secretion in the proximal (increase of 8.7 meq/h, representing 84 +/- 5% of control level) and middle (increase of 1.9 meq/h, representing 16 +/- 2% of control level) segments, while it inhibited acid secretion when infused into the distal segment (decrease of 3.7 meq/h, representing 33 +/- 4% of control level). In contrast, both lipid and carbohydrate inhibited acid secretion similarly (33-38% of control level) at all levels of the bowel. The different effects of protein at different levels of the bowel could not be explained by differences in serum gastrin, different degrees of absorption, or different postabsorptive levels of alpha-amino nitrogen. This suggests the presence of hormonal (nongastrin) or neural mechanisms in the proximal bowel to stimulate acid secretion and/or in the distal bowel to inhibit acid secretion. Thus, factors that determine specific nutrient loads to specific segments of bowel can have important physiological effects on gastric acid secretion.

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