scholarly journals Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kimutai R. Sylvester ◽  
Philip B. Ooko ◽  
Michael M. Mwachiro ◽  
Robert K. Parker
Keyword(s):  
Intestinal Obstruction ◽  
Damage Control ◽  
Symptom Duration ◽  
Delayed Presentation ◽  
Cecal Volvulus ◽  
Resource Limited ◽  
High Index Of Suspicion ◽  
Primary Resection And Anastomosis ◽  
Intestinal Obstructions ◽  
Resection And Anastomosis

Abstract Background Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center. Methods We performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution. Results Thirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001). Conclusions Cecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.

scholarly journals Pediatric Cecal Volvulus: A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Chukwubuike Emeka ◽  
Chukwubuike Emeka
Keyword(s):  
Intestinal Obstruction ◽  
Rare Case ◽  
Clinical Presentation ◽  
Chromosomal Abnormalities ◽  
Cecal Volvulus ◽  
Predisposing Factor ◽  
Case Presentation ◽  
Mobile Cecum ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Introduction: Cecal volvulus (CV) is rare cause of intestinal obstruction especially in children. There is no established protocol for the treatment of CV due to its rarity. Case Presentation: We present a rare case of CV in a 9-year-old girl. Discussion: The spectrum of intestinal malrotation may give rise to a mobile cecum that may result to CV. Constipation could be a predisposing factor. The clinical presentation which may include abdominal pain, distension, constipation and vomiting depends on the time of presentation. There may be associations with chromosomal abnormalities. Conclusion: Although CV is a rare cause of intestinal obstruction, awareness and high index of suspicion is needed by clinician for early diagnosis and treatment.

scholarly journals Post-operative Intussusception, a rare case in pediatric, National Center for Paediatric Surgery, Gezira State, Sudan; 2021

2021 ◽  
Vol 8 (3) ◽  
pp. 001-004
Author(s):  
Omer Taha Ahmed Elmukashfi ◽  
Taha Ahmed Elmukashfi Elsheikh ◽  
Mustafa Abdulaziz Abdalla Ibrahim ◽  
Ahmed Mustafa Idris Mohamed ◽  
Diaaeldinn Yaseen Salman Mohammed
Keyword(s):  
Intestinal Obstruction ◽  
Past History ◽  
Adjacent Segment ◽  
Paediatric Surgery ◽  
Abdominal Ultrasonography ◽  
Palpable Mass ◽  
Abdominal Emergencies ◽  
Ileocecal Intussusception ◽  
High Index Of Suspicion ◽  
Intestinal Obstructions

Intussusception is defined by Treves in 1899 as invagination of segment of bowel into adjacent segment usually proximal into distal. It’s a common cause of abdominal emergencies especially in children two years of age and younger. It accounts for 1 in 2000 infants and children and results in intestinal obstruction. Post-operative intussusception is one of the rare etiologies of intestinal obstruction that represents 0.01 to 0.25% after laparotomies and 5 -10% of all early postoperative intestinal obstructions. Our case is a ten years old female presented to the National Center for Pediatric Surgery; Gezira state; Sudan; February 2021 complaining of abdominal distention and constipation for 6 days. She had past history of acute appendicitis due to which she underwent emergency opened appendectomy. Her condition started one day after appendectomy. O/E : patient looks ill, febrile, not pale or jaundice; PR:140b/m; RR:25c/m; abdominal examination show: distended abdomen with full flanks, unhealed lanz incision with small amount of pus discharge; no dilated veins or visible peristalsis; hernia orifice were intact; lower abdomen was tense & tender; no palpable mass; DRE: rectum contains impacted hard stool. Emergency explorative laparotomy was done. Findings: Ileocecal intussusception, bowel was healthy and viable. Simple reduction was done. Conclusion and Recommendations: Post-operative intussusception usually associated with bowel ischemia and necrosis which is not consistent with our case. We highly recommended abdominal ultrasonography, CT scan; when there is a high index of suspicion.

scholarly journals Outcome of intussusception among children in Kano

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Lawal B. Abdullahi ◽  
Mohammad A. Mohammad ◽  
Lofty-John C. Anyanwu ◽  
Mohammad S. Aliyu ◽  
Bilya I. Liman
Keyword(s):  
Intestinal Obstruction ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Wound Dehiscence ◽  
Exploratory Laparotomy ◽  
Late Presentation ◽  
Adjacent Segment ◽  
Common Cause ◽  
A Prospective Study ◽  
Resection And Anastomosis

Intussusception is defined as the telescoping of a segment of the gastrointestinal tract within the lumen of the adjacent segment usually proximal to distal. It is a common cause of intestinal obstruction in children, rarely it can occur in adult. This condition is reported in both developed and developing countries, however there are few publications in Nigeria about the incidence, presentation and outcome of its management, most especially in children. This is a prospective study of pediatric patients managed in single center Kano over a period of 18months. The demographic data, clinical features, treatment and outcome of the management were evaluated and analyzed using SPSS version 23. Between June 2018 to December 2019, twenty-five children were managed with intussuception at Aminu Kano Teaching Hospital, there were 16 males and 9 females. The age of the patients ranges between 5 months to 6 years with most of patients in the ager range between 6 and 12 months. All of the 25 patients had exploratory laparotomy with manual reduction in 12 patients, while 13 patients had resection and anastomosis. Non-operative reduction using normal saline under ultrasound guidance was attempted for 2 patients, which was not successful. The length of hospital stay ranged between 4 days and 22 days. Few complications were observed which includes surgical site infection, wound dehiscence, postoperative ileus. One patient was re-operated for recurrent intussuception. Two patients died post operatively, while 23 patients were discharged home alive. Intussuception is still a common cause of intestinal obstruction in children in Kano. Late presentation was found to be associated with higher morbidity (complications).

scholarly journals Ultrasonographic Diagnosis of Ileal Intussusception in Calf

2021 ◽  
Vol 49 ◽  
Author(s):  
Ana Clara Sarzedas Ribeiro ◽  
Rodolfo José Cavalcanti Souto ◽  
Tayrlla Polessa Rodrigues Silva ◽  
José Augusto Bastos Afonso ◽  
Carla Lopes Mendonça ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Low Cost ◽  
Clinical Signs ◽  
Chloride Content ◽  
Diagnostic Tools ◽  
Adjacent Segment ◽  
Ultrasound Images ◽  
Target Pattern ◽  
Non Invasive ◽  
Intestinal Obstructions

Background: Intussusception, characterized by invagination of an intestinal segment into the lumen of the adjacent segment, is one of the main causes of intestinal obstruction in cattle, and occurs more frequently in calves. The diagnosis of the disease is based on the history, clinical examination, and complementary exams, which are a challenge in this species, especially in calves, in which transrectal palpation is limited. As it is a non-invasive, effective, and low-cost test, ultrasonography could be an important tool in the diagnosis of intestinal obstructions, in which time is essential for the prognosis. Therefore, the objective was to report a case of intussusception in a calf diagnosed by ultrasound.Case: A 4-month-old calf, weaned at 3 months and raised intensively, was treated at the Clínica de Bovinos de Garanhuns, campus of the Universidade Federal Rural de Pernambuco (CBG/UFRPE), with a history of apathy, anorexia, and dyschezia for 3 days. On physical examination, fever, moderate dehydration, tachycardia, tachypnea with polypnea, bilaterally bulging abdomen, sound of fluid on ballottement, ruminal and intestinal hypomotility, and melena were observed. The hematological findings revealed leukocytosis due to neutrophilia (degenerate neutrophils), hypoproteinemia, and hyperfibrinogenemia. The analysis of the ruminal fluid showed compromised microbiota and increased chloride content. The transabdominal ultrasonography demonstrated, in the right ventral region, hypermotile and full small bowel loops and an increase in the volume of the peritoneal fluid. In addition, there was a segment of the small intestine which, in cross-section, showed multiple concentric rings (“onion rings”, “target pattern”, or “bull’s eye”) and adherence to adjacent loops, compatible with intestinal obstruction due to intussusception. Due to the seriousness of the clinical condition and the ultrasound findings, the animal was euthanized and the necropsy revealed focal fibrinous peritonitis and intestinal obstruction due to intussusception in ileum intestinal segments.Discussion: Intussusception has previously been reported in calves, however this is the first report of ultrasound diagnosis of the disease in Brazil. Although the etiology is rarely confirmed, the age group and recent changes in diet (weaning) were predisposing factors. The history, clinical signs, and laboratory tests were similar to those described in cattle with intussusception, however they may be present in other gastrointestinal illnesses. Other authors have also reported that the nonspecificity of the signs and the impossibility of performing transrectal palpation made it difficult to diagnose intestinal obstruction in calves without the use of other diagnostic tools. As it is a non-invasive and accurate technique, ultrasound has been used in ruminants for diagnostic purposes, including intestinal obstructions. In the present case, the main findings are described as the presence of a lesion with the appearance of multiple concentric rings, hypermotile, dilated, and full intestinal loops. The pathological findings were compatible with the ultrasound images and similar to those described by other authors, confirming the diagnosis. The use of ultrasonography as a diagnostic tool in cattle should be expanded, aiming at the early determination of diagnosis and prognosis, to reduce producer costs and animal discomfort. In cases of intussusception, late diagnosis makes treatment unfeasible.

scholarly journals Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania

2021 ◽  
Vol 9 ◽  
Author(s):  
Audrey Marilyn Smith ◽  
Hendry R. Sawe ◽  
Michael A. Matthay ◽  
Brittany Lee Murray ◽  
Teri Reynolds ◽  
...  
Keyword(s):  
Parental Education ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Transportation Systems ◽  
Care Hospital ◽  
Delayed Presentation ◽  
Suspected Infection ◽  
Logistic Regression Models ◽  
Resource Limited ◽  
Pediatric Sepsis

Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a challenge in resource-limited settings where access to definitive care is limited.Methods: A secondary analysis was performed on data from 1,803 patients (28 days−14 years old) who presented to the emergency department (ED) at Muhimbili National Hospital (MNH) from July 1, 2016 to June 30, 2017 with a suspected infection and ≥2 clinical systemic inflammatory response syndrome criteria. The objective of this study was to determine the relationship between delayed presentation to definitive care (&gt;48 h between fever onset and presentation to the ED) and mortality, as well as the association between socioeconomic status (SES) and delayed presentation. Multivariable logistic regression models tested the two relationships of interest. We report both unadjusted and adjusted odds ratios and 95% confidence intervals.Results: During the study period, 11.3% (n = 203) of children who presented to MNH with sepsis died inhospital. Delayed presentation was more common in non-survivors (n = 90/151, 60%) compared to survivors (n = 614/1,353, 45%) (p ≤ 0.01). Children who had delayed presentation to definitive care, compared to those who did not, had an adjusted odds ratio for mortality of 1.85 (95% CI: 1.17–3.00).Conclusions: Delayed presentation was an independent risk factor for mortality in this cohort, emphasizing the importance of timely presentation to care for pediatric sepsis patients. Potential interventions include more efficient referral networks and emergency transportation systems to MNH. Additional clinics or hospitals with pediatric critical care may reduce pediatric sepsis mortality in Tanzania, as well as parental education programs for recognizing pediatric sepsis.

scholarly journals Transverse colon volvulus in a patient with sickle cell disease

2019 ◽  
Vol 12 (3) ◽  
pp. e228863 ◽  
Author(s):  
Hussain Adnan Abdulla ◽  
Eman Hamza ◽  
Ali Dhaif
Keyword(s):  
Sickle Cell Disease ◽  
Intestinal Obstruction ◽  
Sickle Cell ◽  
Transverse Colon ◽  
Unusual Case ◽  
Large Bowel Obstruction ◽  
Cell Disease ◽  
Postoperative Course ◽  
Colon Volvulus ◽  
High Index Of Suspicion

Although colonic volvulus is a relatively rare cause of large bowel obstruction, accounting for up to 5% of all cases of intestinal obstruction, transverse colon volvulus is extremely uncommon compared with volvulus of the sigmoid colon or caecum and is responsible for only 3% of all reported cases. We report an unusual case of spontaneous volvulus of the transverse colon in a young man with sickle cell disease who underwent resection with primary anastamosis. Having a high index of suspicion and early operative intervention allowed for this patient to have an uneventful postoperative course.

Delayed presentation of a congenital duodenal web managed successfully with incision of web

2020 ◽  
Vol 13 (12) ◽  
pp. e237307
Author(s):  
Mahendra Kumar Jangid ◽  
Reyaz Ahmad ◽  
Sujeet Pandre
Keyword(s):  
Abdominal Pain ◽  
Duodenal Obstruction ◽  
Accurate Diagnosis ◽  
Unusual Presentation ◽  
Contrast Study ◽  
Delayed Presentation ◽  
History Of ◽  
Duodenal Web ◽  
High Index Of Suspicion ◽  
The Web

One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.

scholarly journals Chronic Pulmonary Histoplasmosis—A Scoping Literature Review

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Jacob Baker ◽  
Chris Kosmidis ◽  
Anna Rozaliyani ◽  
Retno Wahyuningsih ◽  
David W Denning
Keyword(s):  
Case Series ◽  
Fungal Culture ◽  
Delayed Presentation ◽  
Antibody Testing ◽  
Historical Case ◽  
Pulmonary Histoplasmosis ◽  
Gradual Loss ◽  
Slow Progression ◽  
Scoping Literature Review ◽  
High Index Of Suspicion

Abstract Chronic pulmonary histoplasmosis (CPH) is an uncommon manifestation of Histoplasma infection with features similar to pulmonary tuberculosis (TB). In endemic areas, it may be misdiagnosed as smear-negative pulmonary TB. Historical case series mainly from patients with presumed TB described a high frequency of cavitation and poor prognosis, likely resulting from delayed presentation. More recent reports suggest that CPH can present with nodules, lymphadenopathy, or infiltrates, with cavities being a less common feature. Emphysema is the main risk factor for cavitary CPH. CPH is therefore an umbrella term, with chronic cavitary pulmonary histoplasmosis and Histoplasma nodules being the main long-term manifestations in nonimmunocompromised individuals. Diagnosis relies on a high index of suspicion, use of fungal culture of respiratory samples, antibody testing, and compatible radiological picture. Treatment with itraconazole for at least 12 months is recommended. Morbidity from CPH results from slow progression of cavities and gradual loss of lung function, especially if not recognized and treated. Studies on the epidemiology of CPH are needed in order to improve understanding of the disease.

scholarly journals Perforated Appendicitis: An Unintended Consequence During the Coronavirus-19 Pandemic

2020 ◽  
Author(s):  
Andrew W Wang ◽  
James Prieto ◽  
Daniel S Ikeda ◽  
Paul R Lewis ◽  
Emily M Benzer ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Disease Process ◽  
Perforated Appendicitis ◽  
The United States ◽  
Military Hospital ◽  
Symptom Duration ◽  
Delayed Presentation ◽  
Historical Cohort ◽  
Surgical Conditions ◽  
The Impact

ABSTRACT Background The coronavirus disease 2019 (COVID-19) pandemic has had major clinical impact across the globe. Delayed presentation for medical emergencies has been noted by the medical community. There has been limited reporting on the impact for the care for emergent surgical conditions. We sought to describe the effect of the global pandemic on the presentation and outcomes for the most common urgent general surgery disease process, acute appendicitis. Methods We performed a retrospective review of patients admitted to the United States Naval Hospital Okinawa during the COVID-19 pandemic, from January 2020 to May 2020 (COVID cohort), and compared them to a historical cohort (pre-COVID cohort) over the prior 2 years. Demographics, clinical presentation data, and interventions were collected. Results Of the 80 patients with appendicitis, 20% presented perforated. Most patients were male (71%), presented with 1 day of symptoms and had a length of stay of 1 to 2 days. Comparing groups, 13% of the pre-COVID group vs. 31% of the COVID cohort presented perforated (P = .04), with a symptom duration of 1.6 vs. 2.7 days before presentation (P = .075), respectively. Conclusions The COVID-19 pandemic and the global systematic response has impacted unrelated medical and surgical conditions. At our overseas military hospital with minimal disease burden, we observed a delay in presentation for acute appendicitis with a higher incidence of perforation. Patients should be empowered to continue to seek care for urgent and emergent medical and surgical conditions so that they are not harmed by fear of COVID-19 rather than by COVID-19 itself.

Cecal volvulus causing postoperative intestinal obstruction

2001 ◽  
Vol 44 (6) ◽  
pp. 893-895 ◽  
Author(s):  
Carl W. Konvolinka ◽  
Richard A. Moore ◽  
Kulvinder Bajwa
Keyword(s):  
Intestinal Obstruction ◽  
Cecal Volvulus ◽  
Postoperative Intestinal Obstruction
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