scholarly journals Fetal Midgut Volvulus with a Cystic Appearance, Accompanying a Sinus Rhythm and an Increased Peak Systolic Velocity without Anemia

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Metin Kaba ◽  
Aysegul Oksuzoglu ◽  
Gokcen Kaba ◽  
Hakan Timur ◽  
Eren Akbaba ◽  
...  
Keyword(s):  
Small Bowel ◽  
Multiorgan Failure ◽  
Peak Systolic Velocity ◽  
Cystic Mass ◽  
Bowel Loop ◽  
Midgut Volvulus ◽  
Female Fetus ◽  
Uterine Contractions ◽  
Abdominal Radiographs ◽  
Necrotic Bowel

A midgut volvulus rarely occurs in a fetus; however, when it does, it requires an immediate diagnosis and surgery. Thirty-week pregnant was referred to our clinic with a diagnosis of a fetal abdominal cystic mass and preterm labor. The initial ultrasound examination revealed a female fetus with a 55 × 50 mm cystic mass in the lower abdomen, which was preliminarily diagnosed as an ovarian cyst. There was a sinusoidal rhythm on cardiography. The middle cerebral artery peak systolic velocity was 60.4 cm/sec, compatible with 1.49 MoMs that suggested fetal anemia on Doppler examination. Uterine contractions were observed with tocography and maternal hydration was administered for tocolytic treatment. Despite hydration, uterine contractions continued and the infant was delivered. A newborn ultrasonographic evaluation revealed a 6 cm abdominal cyst, and plain abdominal radiographs revealed distended loops of the small bowel on the left side. Emergency surgery was performed. A midgut volvulus leading to dilatation and necrosis of the small bowel without anatomical causes was observed during laparotomy. The necrotic bowel loop was resected and an end-to-end anastomosis was performed. The newborn died due to multiorgan failure. Obstetricians should be familiar with the appropriate diagnosis and management of a fetal volvulus.

scholarly journals Mesenteric Lymphatic Malformation Causing Midgut Volvulus in an Adult: An Unusual Presentation

2021 ◽  
Author(s):  
Surya Nandan Prasad ◽  
Rani Kunti R. Singh ◽  
Pragya Chaturvedi ◽  
Vivek Singh
Keyword(s):  
Small Bowel ◽  
Closed Loop ◽  
Pediatric Population ◽  
Lymphatic Malformation ◽  
Bowel Loop ◽  
Midgut Volvulus ◽  
Lymphatic Malformations ◽  
Rare Presentation ◽  
Whirlpool Sign ◽  
Work Up

AbstractMesentery is an uncommon location for occurrence of lymphatic malformations. Lymphatic malformations causing midgut volvulus are described in pediatric population; however, it is a rare presentation in adults. We present case of 20-year-old man with a large mesenteric lymphatic malformation who presented with acute abdominal complaints. On radiological work up, the lymphatic malformation was seen causing midgut volvulus and closed loop small bowel obstruction with the presence of classical whirlpool sign. The patient underwent emergency surgery and the lymphatic malformation was completely excised along with resection of a segment of small bowel loop.

scholarly journals Intestinal obstruction due to small bowel herniation through foramen of Winslow: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
P. K. B. S. C. Bandara ◽  
A. M. Viraj Rohana ◽  
Aloka Pathirana
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Intestinal Obstruction ◽  
Reflux Disease ◽  
Bowel Loop ◽  
Internal Herniation ◽  
Small Bowel Loop ◽  
Foramen Of Winslow

Abstract Background Intestinal obstruction due to internal herniation of the bowel is a rare clinical entity which is often overlooked in the differential diagnosis of patients with abdominal pain who have no previous history of abdominal surgery. Several sites of bowel internal herniation have been described, amongst which internal herniation through the foramen of Winslow accounts for about 8% of cases. These patients present with nonspecific abdominal pain associated with symptoms of gastroesophageal reflux disease, and hence the diagnosis is often overlooked. The usual symptoms of intestinal obstruction can be delayed, which results in a delay in diagnosis and gangrene of the herniated bowel segment. Abdominal radiographs and computed tomography are helpful in the diagnosis. Open reduction is the management of choice; however, laparoscopic reduction has also been attempted, with good results. Case presentation We report a case of a middle-aged Sri Lankan man who presented with features of gastroesophageal reflux disease, developed features of intestinal obstruction and was found to have a gangrenous small bowel loop which had herniated through the foramen of Winslow. Following needle aspiration and reduction of the herniated small bowel loop, the gangrenous part of the small bowel was resected and an ileoileal anastomosis performed. The large foramen of Winslow was partially closed with interrupted stitches. The patient made an uneventful recovery. Conclusion Since delayed diagnosis of bowel obstruction is detrimental, it is of utmost importance to diagnose it early. Because internal herniation of the small bowel through the foramen of Winslow presents with nonspecific symptoms including features of gastroesophageal reflux disease, as documented in several cases worldwide and also presented by our patient, there should be a high degree of suspicion of internal herniation of the bowel causing bowel obstruction and low threshold for extensive investigation of patients presenting with symptoms of gastroesophageal reflux disease which does not resolve with usual medication.

scholarly journals Plain Abdominal Radiographs: Can we Interpret Them?

2006 ◽  
Vol 88 (1) ◽  
pp. 23-26 ◽  
Author(s):  
C Beverly B Lim ◽  
Vivian Chen ◽  
Allon Barsam ◽  
Jeremy Berger ◽  
Richard A Harrison
Keyword(s):  
Small Bowel ◽  
Large Bowel ◽  
Correct Diagnosis ◽  
Abdominal Radiograph ◽  
Junior Doctors ◽  
Plain Abdominal Radiograph ◽  
Upper Limit ◽  
Diagnostic Role ◽  
Abdominal Radiographs ◽  
Normal Dimension

INTRODUCTION Plain abdominal radiographs commonly form a part of medical assessments. Most of these films are interpreted by the clinicians who order them. Interpretation of these films plays an important diagnostic role and, therefore, influences the decision for admission and subsequent management of these patients. The aim of this study was to find out how well doctors in different specialties and grades interpreted plain abdominal radiographs. MATERIALS AND METHODS A total of 76 doctors from the Departments of Accident & Emergency, Medicine, Surgery and Radiology (17, 32, 23 and 4, respectively) participated in the study which involved giving a diagnosis for each of 14 plain abdominal radiographs (5 ‘normal’ and 9 ‘abnormal’). They were also asked the upper limit of normal dimensions of small bowel and large bowel. One point was awarded for correctly identifying whether a radiograph was normal/abnormal, 1 point for the correct diagnosis and 1 point for the correct bowel dimensions, giving a total score of 30. RESULTS Mean scores out of 30 for specialties were as follows: Accident & Emergency 13.1 (range, 2–22), Medicine 11.2 (range, 2–23), Surgery 15.0 (range, 8–24) and Radiology 17.0 (range, 14–20; P = 0.241). Mean scores out of 30 for different grades of doctors were as follows: pre-registration house officers 10.8 (range, 4–20), senior house officers 13.0 (range, 2–22), registrars/staff grades 13.8 (range, 2–23) and consultants 17.3 (range, 12–24; P = 0.028). Fifteen out of 76 (19.7%) doctors correctly identified the upper limit of normal dimension of small bowel; 24 out of 76 (31.6%) correctly identified the upper limit of normal dimension of large bowel. DISCUSSION The level of seniority positively correlated with skills of plain abdominal radiograph interpretation. A large number of doctors were unable to give the correct upper limit of normal dimensions for small and large bowel. CONCLUSIONS All doctors could benefit from further training in the interpretation of plain abdominal radiographs. This could perhaps take place as formal teaching sessions and be included in induction programmes. Until then, plain abdominal films should ideally be reported by radiologists where there are clinical uncertainties; important management decisions made by junior doctors based on these films should at least be confirmed with a registrar, if not a consultant.

scholarly journals Case Report: Seaweed Bezoar Masquerading as a Malignant Obstruction

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
E. C. Abboud ◽  
B. Babic
Keyword(s):  
Small Bowel ◽  
High Sensitivity ◽  
Bowel Loop ◽  
Asian Woman ◽  
Malignant Obstruction ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Risk Patients ◽  
High Index Of Suspicion

Bezoars represent a rare cause of small bowel obstruction (SBO). Nonoperative management of bezoars includes use of endoscopy with mechanical or chemical dissolution methods. When obstruction persists, surgical intervention becomes necessary. Here, we present the case of an Asian woman with a SBO secondary to a phytobezoar masquerading as a malignancy. She presented with two days of acute-on-chronic abdominal pain that started after eating seaweed. Initial computed tomography (CT) scan showed a SBO with a jejunal transition point and ill-defined liver lesions, worrisome for a malignant obstruction with liver metastases. Further imaging, however, showed the resolution of these artifacts. Subsequent laparotomy revealed a small bowel loop with copious obstructing seaweed. A distal stricture was palpated, and the involved segment was resected. Intraoperative liver ultrasound was negative, and final pathology revealed benign small intestine with a mild stricture. Given the rarity of bezoar-related obstructions, the diagnosis is often delayed particularly when confounding factors exist such as our patient’s concomitant hepatic findings. Contrast-enhanced CT has a high sensitivity but a lower specificity in identifying bezoars. A high index of suspicion is therefore necessary especially when managing higher risk patients.

scholarly journals Large intra-abdominal dermoid cyst presenting as small bowel volvulus

2017 ◽  
Vol 4 (9) ◽  
pp. 3188 ◽  
Author(s):  
Suneed Kumar ◽  
Gurudutt Varty
Keyword(s):  
Small Bowel ◽  
Dermoid Cyst ◽  
Surgical Intervention ◽  
Abdominal Distension ◽  
Cystic Mass ◽  
Lower Abdomen ◽  
Small Bowel Volvulus ◽  
Abdominal Emergencies ◽  
Acute Small Bowel Obstruction ◽  
Uncommon Location

Intestinal obstruction is one of the commonest abdominal emergencies requiring surgical intervention. Among its numerous causes, volvulus of the small and large bowel plays a less common aetiological role. This is a rare case of a large intra-abdominal dermoid cyst causing small bowel volvulus and presenting as obstruction. 46-year-old male presented with four-day history suggestive of acute small bowel obstruction, with gross abdominal distension on examination. With minimal investigations, he was explored to reveal a large 10×8 cm sized cystic mass in lower abdomen, with two vascular pedicles causing twisting of small bowel and resultant obstruction. Surgical intervention included unwinding of viable bowel, dividing pedicles and excision of the mass. The cyst was found to contain pultaceous material with hair and solid components. Patient tolerated the procedure well and was asymptomatic on discharge and subsequent follow-ups. This case illustrates an uncommon cause of a common presentation; an uncommon location of a relatively common cystic swelling; and the diagnostic surprise that was encountered during the management, thereby reiterating the need for keen observation and clinical acumen while dealing with such cases.

Surgeon's tactics for relaparotomy after small bowel anastomosis in children

1980 ◽  
Vol 61 (5) ◽  
pp. 16-19
Author(s):  
E. V. Ulrih ◽  
U. S. Belenkiy
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Bowel Loop ◽  
Bowel Anastomosis

The main complications after resection of the small intestine in 87 out of 560 operated children are described. With peritonitis, which developed as a result of the divergence of the anastomotic sutures, it is preferable to remove the bowel loop carrying the anastomosis to the anterior abdominal wall.

scholarly journals Gastric remnant perforation due to trocar site herniation after laparoscopic Roux-en-Y gastric bypass

2019 ◽  
Vol 101 (3) ◽  
pp. e88-e90
Author(s):  
R Ebrahimi ◽  
M Kermansaravi ◽  
F Eghbali ◽  
A Pazouki
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Diagnostic Laparoscopy ◽  
Gastric Remnant ◽  
Bowel Loop ◽  
Low Grade ◽  
Small Bowel Loop ◽  
Trocar Site

A 39-year-old woman was admitted with colicky left upper-quadrant pain, dyspnoea, low-grade fever, tachycardia and a subtle left upper-quadrant tenderness without leucocytosis. Computed tomography revealed a distended gastric remnant due to small-bowel loop herniation at the trocar site. The patient underwent a diagnostic laparoscopy as her general condition worsened. Perforation across the staple line was seen and repaired. The postoperative period was uneventful. As a rare complication of laparoscopic Roux-en-Y gastric bypass, small-bowel obstruction is of great importance because it can lead to gastric remnant perforation if not managed correctly. There have been rare reports of trocar site herniation as a cause of small-bowel obstruction following laparoscopic Roux-en-Y gastric bypass. Prompt diagnostic laparoscopy should be considered. This is the first case reported in which the excluded stomach was perforated due to trocar site herniation of the small-bowel loop. It should be noted that the tissue around the perforation is fragile and proper tension should be employed when it is repaired. Generally, an omental patch is not encouraged.

The significance of abdominal radiographs with paucity of gas in pediatric adhesive small bowel obstruction

2020 ◽  
Vol 220 (1) ◽  
pp. 208-213
Author(s):  
Brittany L. Johnson ◽  
Giovanni A. Campagna ◽  
Jonathan M. Hyak ◽  
Adam M. Vogel ◽  
Sara C. Fallon ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Adhesive Small Bowel Obstruction ◽  
Abdominal Radiographs

scholarly journals Clostridium difficileEnteritis after Total Abdominal Colectomy for Ulcerative Colitis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Hassan Nasser ◽  
Semeret Munie ◽  
Dania Shakaroun ◽  
Tommy Ivanics ◽  
Surya Nalamati ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Small Bowel ◽  
Case Reports ◽  
Multiorgan Failure ◽  
Rare Condition ◽  
Nucleic Acid Amplification ◽  
Wall Thickening ◽  
Total Proctocolectomy ◽  
High Dose ◽  
Port Site Hernia

Introduction.IsolatedClostridium difficilesmall bowel enteritis is a rare condition with significant morbidity and mortality.Presentation of Case.An 83-year-old female with refractory ulcerative colitis underwent a total proctocolectomy and end ileostomy. Her postoperative course was complicated with return to the operating room for repair of an incarcerated port site hernia. Subsequently, she developed septic shock and multiorgan failure requiring intubation and mechanical ventilation, renal replacement therapy, and high dose vasopressors. Diagnostic workup revealed diffuse small bowel wall thickening on computed tomography scan as well as positive nucleic acid amplification test forC. difficiletoxin B gene. Despite treatment with antibiotics and maximum attempts at resuscitation, the patient expired.Discussion. C. difficileinfection most commonly affects the colon but rarely can involve the small bowel. The pathogenesis ofC. difficileenteritis is unclear but is believed to mirror that of colitis. Surgical patients are susceptible forC. difficileinfection, as they tend to be relatively immunosuppressed in the postoperative period. Radiologic findings of enteritis may mimic those of colitis and this includes small bowel dilation and thickening. Treatment for this condition has not been well established but it is approached similar to colitis.Conclusion.Despite an increase in the number of case reports ofC. difficileenteritis, it continues to be a rare but potentially fatal infection. Clinicians should maintain a high index of suspicion especially in patients with inflammatory bowel disease who undergo colon resections.

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