Colonic Volvulus

2014 ◽  
Author(s):  
Kevin R. Kasten ◽  
Peter W. Marcello ◽  
Todd D. Francone
Keyword(s):  
United States ◽  
Splenic Flexure ◽  
Transverse Colon ◽  
The United States ◽  
Sigmoid Volvulus ◽  
Rectal Tube ◽  
Radiographic Findings ◽  
Colonic Volvulus ◽  
Ileosigmoid Knot ◽  
Colon Volvulus

Colonic volvulus accounts for 3 to 5% of bowel obstructions in the United States. Current data reveal sigmoid volvulus as the most common colonic volvulus, followed by volvulus of the cecum, transverse colon, and splenic fixture. Despite a low incidence in the United States, diagnosis, management, and patient outcome depend on an appropriate index of suspicion and adherence to the proposed algorithm highlighting the approach to the patient with colonic volvulus. This review outlines the definition, pathogenesis, and epidemiology of colonic volvulus, as well as its clinical evaluation and treatment. Tables review the demographics of colonic volvulus in the United States, the differential diagnosis of and risk factors for colonic volvulus, important radiographic findings in colonic volvulus, and nonoperative management of sigmoid volvulus. Figures show the types of ileosigmoid knot; plain radiographs of cecal,  sigmoid, transverse, and splenic flexure volvulus; contrast enema of cecal, transverse, splenic flexure, and sigmoid volvulus; cross-sectional abdominal imaging of cecal, sigmoid, and transverse colon volvulus and ileosigmoid knot; endoscopic evaluation in sigmoid volvulus; use of an esophageal overtube for placement of a rectal tube; necrotic cecum and transverse colon volvulus in the operating suite; and sigmoid volvulus in an elderly gentleman. This review contains 14 figures, 5 tables, and 158 references.

scholarly journals Community-Acquired Pneumonia due to Streptococcus pneumoniae: When to Consider Coinfection with Active Pulmonary Tuberculosis

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Ruslan Garcia
Keyword(s):  
United States ◽  
Mycobacterium Tuberculosis ◽  
Streptococcus Pneumoniae ◽  
Pulmonary Tuberculosis ◽  
The United States ◽  
Geographic Region ◽  
Community Acquired Pneumonia ◽  
Radiographic Findings ◽  
Delay In Diagnosis ◽  
Active Pulmonary Tuberculosis

Community-acquired pneumonia (CAP) is an important cause of hospitalizations in adults. In the United States, Streptococcus pneumoniae is the most frequently identified bacterial pathogen responsible for CAP. Other etiologic pathogens of CAP vary based on the geographic region. Mycobacterium tuberculosis is an uncommon cause of CAP in the United States, while it is a principal cause in many African and Asian countries. Coinfection with Streptococcus pneumoniae and Mycobacterium tuberculosis is rare and has only been reported in the setting of underlying HIV infection in areas of high tuberculosis prevalence. Here, we report a case of CAP in the absence of HIV, where Streptococcus pneumoniae was identified on admission and delay in diagnosis of concomitant active pulmonary tuberculosis led to inappropriate isolation. In addition to a high index of suspicion, epidemiologic and radiographic findings can be helpful to recognize tuberculosis as a cause of CAP even when other pathogens have already been identified.

Colonic Volvulus in the United States

2014 ◽  
Vol 259 (2) ◽  
pp. 293-301 ◽  
Author(s):  
Wissam J. Halabi ◽  
Mehraneh D. Jafari ◽  
Celeste Y. Kang ◽  
Vinh Q. Nguyen ◽  
Joseph C. Carmichael ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Colonic Volvulus

scholarly journals Macrolide-Resistant Mycoplasma pneumoniae in the United States as Determined from a National Surveillance Program

2019 ◽  
Vol 57 (11) ◽  
Author(s):  
K. B. Waites ◽  
A. Ratliff ◽  
D. M. Crabb ◽  
L. Xiao ◽  
X. Qin ◽  
...  
Keyword(s):  
United States ◽  
Clinical Significance ◽  
Mycoplasma Pneumoniae ◽  
The United States ◽  
Antimicrobial Treatment ◽  
23S Rrna ◽  
Surveillance Program ◽  
National Surveillance ◽  
Radiographic Findings ◽  
Content Type

ABSTRACT There are sparse data to indicate the extent that macrolide-resistant Mycoplasma pneumoniae (MRMp) occurs in the United States or its clinical significance. Between 2015 and 2018, hospitals in 8 states collected and stored respiratory specimens that tested positive for M. pneumoniae and sent them to the University of Alabama at Birmingham, where real-time PCR was performed for detection of 23S rRNA mutations known to confer macrolide resistance. MRMp was detected in 27 of 360 specimens (7.5%). MRMp prevalence was significantly higher in the South and East (18.3%) than in the West (2.1%). A2063G was the predominant 23S rRNA mutation detected. MICs for macrolide-susceptible M. pneumoniae (MSMp) were ≤0.008 μg/ml, whereas MICs for MRMp were 16 to 32 μg/ml. Patients with MRMp infection were more likely to have a history of immunodeficiency or malignancy. Otherwise, there were no other significant differences in the clinical features between patients infected with MRMp and those infected with MSMp, nor were there any differences in radiographic findings, hospitalization rates, viral coinfections, the mean duration of antimicrobial treatment, or clinical outcomes. There was no significant change in MRMp incidence over time or according to age, sex, race/ethnicity, or status as an inpatient or an outpatient. Patients with MRMp were more likely to have received a macrolide prior to presentation, and their treatment was more likely to have been changed to a fluoroquinolone after presentation. This is the first national surveillance program for M. pneumoniae in the United States. Additional surveillance is needed to assess the clinical significance of MRMp and to monitor changes in MRMp prevalence.

Amebic Liver Abscess in Children: Clinical and Epidemiologic Features

PEDIATRICS ◽  
1979 ◽  
Vol 64 (6) ◽  
pp. 923-928
Author(s):  
H. Robert Harrison ◽  
C. Peter Crowe ◽  
Vincent A. Fulginiti
Keyword(s):  
United States ◽  
Abdominal Pain ◽  
Respiratory Distress ◽  
Liver Abscess ◽  
Hepatic Abscess ◽  
The United States ◽  
Amebic Liver Abscess ◽  
Radiographic Findings ◽  
Left Shift ◽  
Epidemiologic Features

Amebiasis, that is, infection with Entameba histolytica, continues to be endemic in the United States, with liver abscess occurring as an infrequent but constant complication. Seven cases are reported, with epidemiologic investigation of two. Reliable findings in hepatic abscess include fever, abdominal pain, respiratory distress, tender abdomen, and large, tender liver. Anemia, elevated white count with left shift, and the radiographic findings of an elevated right hemidiaphragm are constant. Epidemiologically, amebiasis occurs in clusters in the United States with person-to-person transmission pre-dominant in spread. Infection is associated with poor sanitation and crowding. Investigation of the families of two patients documented 9/21 carriers and an additional 3/21 who were seropositive, as well as crowding and poor sanitation. In this country, treatment of a patient with amebic disease should include investigation of his home and family.

scholarly journals 763. Risk Factors for Homeless Status and Mortality Among Homeless TB Cases in Texas, 2010–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S274-S274 ◽  
Author(s):  
Saroochi Agarwal ◽  
Duc T Nguyen ◽  
Edward A Graviss
Keyword(s):  
United States ◽  
Risk Factors ◽  
Care Facility ◽  
Information Management System ◽  
The United States ◽  
Case Definition ◽  
Foreign Born ◽  
Excessive Alcohol Consumption ◽  
Term Care ◽  
Radiographic Findings

Abstract Background A disproportionate amount of tuberculosis (TB) cases and mortality occur among people experiencing homelessness in the United States. Our objective was to identify risk factors for mortality among reported homeless TB cases in Texas, a state with an increased TB prevalence in the United States. Methods Using data from the Centers for Disease Control and Prevention TB Genotyping Information Management System (TB GIMS), we evaluated the demographic, laboratory and clinical characteristics of people identified as being homeless in the year preceding TB diagnosis in Texas from January 1, 2010 to December 31, 2017. TB cases with missing or unknown homeless status were removed from the analysis. Multivariate logistic regression was used to analyze and evaluate risk factors associated with homeless status and mortality among homeless TB cases. Results Of the 10,103 newly diagnosed TB cases over the 8-year period, 543 (5.4%) were reported as being homeless in the year preceding TB diagnosis. In 412 homeless TB patients with a reported outcome as “died” or “completed,” 57 (13.8%) died during treatment and 355 (86.2%) completed therapy. Age >45, male, black ethnicity, foreign-born, urban living, excessive alcohol consumption, IDU, long-term care facility resident, diabetes, previous TB, and pulmonary TB were associated with homeless TB cases. Being homeless and having TB increased the risk of mortality compared with having TB alone (OR 2.26, P < 0.01). Age >45 years, positive HIV status, cavitary and miliary radiographic findings, no or unknown culture conversion and TB case confirmation by a positive culture/NAA/smear compared with clinical case definition/provider diagnosis were independent risk factors for mortality among homeless TB cases in Texas. Conclusion Being homeless increased the risk of TB mortality by nearly 130% compared with being housed prior to TB diagnosis. Our findings indicate that homelessness may be being diagnosed and treated in more advanced TB diseased homeless individuals who probably have poorer health due to the stresses of poverty, comorbidities, and lack of access to healthcare, leading to higher mortality. Additionally, testing and treatment for HIV among those reporting homelessness may reduce mortality among this high-risk group. Disclosures All authors: No reported disclosures.

scholarly journals Orbital Infarction due to Sickle Cell Disease without Orbital Pain

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Cameron L. McBride ◽  
Kim-Binh T. Mai ◽  
Kartik S. Kumar
Keyword(s):  
United States ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
The United States ◽  
Acute Onset ◽  
Cell Disease ◽  
Radiographic Findings ◽  
Orbital Pain ◽  
Soft Tissue Swelling ◽  
High Index Of Suspicion

Sickle cell disease is a hemoglobinopathy that results in paroxysmal arteriolar occlusion and tissue infarction that can manifest in a plurality of tissues. Rarely, these infarcted crises manifest in the bony orbit. Orbital infarction usually presents with acute onset of periorbital tenderness, swelling, erythema, and pain. Soft tissue swelling can result in proptosis and attenuation of extraocular movements. Expedient diagnosis of sickle cell orbital infarction is crucial because this is a potentially sight-threatening entity. Diagnosis can be delayed since the presentation has physical and radiographic findings mimicking various infectious and traumatic processes. We describe a patient who presented with sickle cell orbital crisis without pain. This case highlights the importance of maintaining a high index of suspicion in patients with known sickle cell disease or of African descent born outside the United States in a region where screening for hemoglobinopathy is not routine, even when the presentation is not classic.

scholarly journals A Case of Transverse Colon Volvulus after Sigmoid Resection for Sigmoid Volvulus

2017 ◽  
Vol 78 (7) ◽  
pp. 1570-1573
Author(s):  
Taisuke MATSUOKA ◽  
Nobuyuki KIKUCHI ◽  
Yoshiaki TAKAHASHI ◽  
Kanefumi YAMASHITA ◽  
Suguru HASEGAWA
Keyword(s):  
Transverse Colon ◽  
Sigmoid Resection ◽  
Sigmoid Volvulus ◽  
Colon Volvulus

scholarly journals UNUSUAL PRESENTATION OF ACUTE INTESTINAL OBSTRUCTION DUE TO TRANSVERSE COLON VOLVULUS IN LATE PREGNANCY

2020 ◽  
Vol 7 (3) ◽  
pp. 106-109
Author(s):  
Muad Gamil M. Haidar ◽  
Nuha Ahmed H. Sharaf ◽  
Mayada Mohamed Al-Dankali
Keyword(s):  
Intestinal Obstruction ◽  
Transverse Colon ◽  
Primary Anastomosis ◽  
Colonic Obstruction ◽  
Late Pregnancy ◽  
Abdominal Ultrasound ◽  
Fetal Mortality ◽  
Contributing Factors ◽  
Colonic Volvulus ◽  
Colon Volvulus

Transverse colon volvulus is the rarest type of colonic volvulus, with a higher morbidity and mortality rate. In pregnancy, intestinal obstruction due to transverse colon volvulus is rare and seldom reported, and its timely diagnosis can be difficult. We report an unusual case of transverse colon volvulus in a young female at late-term pregnancy. A 28-years-old, pregnant woman, gravida 2, para 1, at 34 weeks of gestation, presented with progressive abdominal pain and distention, commencing about 12 hours prior to admission, associated with vomiting and obstipation.  Vital signs were stable. However, the abdomen was asymmetrically hugely distended.  The initial abdominal ultrasound showed a single viable intrauterine fetus and dilated loops of bowels. As fetal distress progressed throughout the admission, a laparotomy was performed, which revealed an unexpected transverse colonic volvulus. Resection of the twisted segment and primary anastomosis were performed, followed by a cesarean section to deliver the baby. The mother made a satisfactory recovery. Although this patient’s preoperative clinical findings suggested colonic obstruction, the diagnosis of transverse colonic volvulus was only made intraoperatively and has seldom been previously described. Chronic constipation, the enlarging uterus, and the anatomical redundancy of the transverse colon may have been contributing factors. Transverse colon volvulus in late pregnancy is uncommon. Early diagnosis and prompt surgical intervention can significantly minimize maternal and fetal mortality.

Volvulus of the Transverse Colon

2021 ◽  
pp. 000313482110415
Author(s):  
Sergio Huerta ◽  
Maryanne L. Pickett ◽  
Ann M. Mottershaw ◽  
Pramod Gupta ◽  
Thai Pham
Keyword(s):  
World Literature ◽  
Present Report ◽  
The United States ◽  
Large Bowel Obstruction ◽  
Sigmoid Volvulus ◽  
Cecal Volvulus ◽  
Colonic Volvulus ◽  
Cardiopulmonary Complications ◽  
Common Operation ◽  
Colonoscopic Decompression

Background In the United States, the third leading cause of a large bowel obstruction (LBO) is colonic volvulus with torsion occurring most commonly in the sigmoid and the cecum. Transverse colonic volvulus (TCV) is exceedingly rare and specific involvement of the splenic flexure (SFV) is even less common. The present analysis was undertaken to interrogate current trends in presentation, management, and outcomes of TCV. Methods In the present report, the world literature was reviewed for the past 90 years (1932 to 2021). We conducted a systematic review to identify all cases of TCV following the PRISMA guidelines. Results We identified 317 cases of TCV. This included SFV (n = 75), TCV in pediatric patients (n = 63), TCV in pregnant patients (n = 8), and TCV associated with other pathology such as Chilaiditi’s syndrome (n = 11). Compared to sigmoid and cecal volvulus, TCV was rare (.94%). It affected slightly more women (54%) than men, commonly in their third decade of life (37.7 ± 23.8). The clinical presentation and diagnostic imaging were consistent with LBO. Compared to sigmoid volvulus, there was a limited role for conservative management and colonoscopic decompression was less effective. The most common operation was segmental resection (25%). Mortality was (20%) commonly because of cardiopulmonary complications and affected more women (63%). The average age of this cohort was 55.7±24.6 years old. Discussion Our review showed that TCV is an uncommon surgical entity. The diagnosis is likely to be made at laparotomy. Prompt recognition is paramount in preventing ischemia necrosis and perforation. Compared to sigmoid and cecal volvulus, the mortality for TCV remains high.

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