scholarly journals Right retrocolic intrasaccular duodenum: Is it a novel variant of isolated duodenal nonrotation? A case report

2022 ◽  
Vol 11 ◽  
pp. 5
Author(s):  
Mirzaman Huseynov
Keyword(s):  
Terminal Ileum ◽  
Rare Variants ◽  
Ascending Colon ◽  
Right Colon ◽  
Ileocecal Region ◽  
Case Presentation ◽  
Bilious Vomiting ◽  
Novel Variant ◽  
The Right ◽  
Almost All

Background: Almost all of the studies on anomalies of the midgut rotation and fixation in the literature and related sections in textbooks were designed according to Dott's classification. Focusing only on common rotation anomalies has led to the exclusion and neglect of other rare variants. Isolated pure duodenal nonrotation is such a variant. Case Presentation: We report a case of an unusual form of isolated pure duodenal nonrotation, in a 3-day-old newborn presenting with bilious vomiting. Ultrasonographic examination revealed the sign of 'whirlpool'. When this finding was evaluated together with bilious vomiting, midgut volvulus was considered and the patient was operated on urgently. Peroperatively, it was observed that the jejunum entered between the leaves of the terminal ileum mesentery. Proximally, the duodenum was located posterior to the right colon in a "sack". This "sack" was surrounded by thick Ladd's bands laterally, mesentery of the ascending colon medially, the posterior surface of the cecum and ascending colon anteriorly, and by the posterior abdominal wall posteriorly. Conclusion: In isolated duodenal nonrotation, the duodenum may be completely retro-colic. Consequently, the duodenojejunal junction and the ileocecal region may almost overlap. Unlike isolated duodenal nonrotation cases, in the surgical treatment of this variant, separation of Ladd bands alone is not sufficient, additionally, the right colon should be placed in a nonrotation position and care should be taken not to kink the terminal ileum under the cecum.

Is Laparoscopic CME Right Hemicolectomy an Optimal Indication for NET of the Right Colon and Terminal Ileum?

2020 ◽  
Author(s):  
C. Pedrazzani ◽  
C. Conti ◽  
A. Valdegamberi ◽  
M. V. Davì ◽  
S. Cingarlini ◽  
...  
Keyword(s):  
Terminal Ileum ◽  
Right Hemicolectomy ◽  
Right Colon ◽  
The Right

scholarly journals Segmental colonic length and mobility

2015 ◽  
Vol 97 (6) ◽  
pp. 439-444 ◽  
Author(s):  
M Phillips ◽  
A Patel ◽  
P Meredith ◽  
O Will ◽  
C Brassett
Keyword(s):  
Significant Proportion ◽  
Human Colon ◽  
Ascending Colon ◽  
Rectosigmoid Colon ◽  
Right Colon ◽  
Transverse Mesocolon ◽  
Anatomical Teaching ◽  
The Mean ◽  
The Right ◽  
Sigmoid Mesocolon

Introduction Locoregional variation in the human colon is important in surgical practice; the length and mobility of different colonic regions impacts on laparoscopic and endoscopic colorectal procedures. The aim of this study was to refine anatomical understanding of the colon in terms of segmental length and mobility. Methods The colons of 35 cadavers were examined to determine lengths of caecum as well as ascending, transverse, descending and rectosigmoid colon, and to characterise colonic mobility at each location in terms of the mesenteric attachments. The presence of Jackson’s membrane (a congenital peritoneal band of the right colon) was also documented. Results The mean total colonic length was 131.2cm (standard deviation [SD]: 13.4cm). There was no correlation with height, age or sex; the best predictor of total colonic length was the length of the rectosigmoid segment. The mean height of the transverse mesocolon was 7.4cm (SD: 3.6cm) and that of the sigmoid mesocolon was 6.3cm (SD: 2.6cm). Two-thirds of the subjects had a mobile portion of the ascending colon and nearly one-third had a mobile descending colon. A mobile ascending colon was significantly more common in females. Jackson’s membrane was present in 66% of the subjects. Conclusions This cadaveric study suggests that rectosigmoid length accounts for most of the variability in total colonic length. The significant proportion of colons with mobility of the ascending and descending segments prompts revision of the traditional anatomical teaching of these segments as fixed and retroperitoneal. Mobility of the ascending colon may account for the anecdotal finding that colonoscopy is more challenging in female patients. Jackson’s membrane was identified in most colons.

scholarly journals Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels

2021 ◽  
Author(s):  
Salomone Di Saverio ◽  
Kostantinos Stasinos ◽  
Weronyka Stupalkowska ◽  
Umberto Bracale ◽  
Pierpaolo Sileri ◽  
...  
Keyword(s):  
Splenic Flexure ◽  
Primary Anastomosis ◽  
Colorectal Anastomosis ◽  
Ascending Colon ◽  
Right Colon ◽  
Left Hemicolectomy ◽  
Tension Free ◽  
Descending Colon ◽  
Deloyers Procedure ◽  
The Right

Abstract Introduction This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis. Background While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article. Technique and methods Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient. Results This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery. Conclusions Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function.

scholarly journals Large Bowel Occlusion: Clinical and Imaging Characteristics - Caecum Volvulus

2019 ◽  
Vol 7 (13) ◽  
pp. 2150-2153
Author(s):  
Danilo Coco ◽  
Silvana Leanza
Keyword(s):  
Abdominal Pain ◽  
Terminal Ileum ◽  
Large Bowel ◽  
Death Rate ◽  
Ascending Colon ◽  
Case Presentation ◽  
Imaging Characteristics ◽  
Life Threatening ◽  
Bowel Occlusion ◽  
Anatomical Finding

BACKGROUND: Caecum volvulus (CV) is defined as an axial twisting that causes an inversion position of the caecum, ascending colon and terminal ileum. This anatomical finding is responsible for some clinical features. Obstruction and strangulation are the most important and life-threatening. CASE PRESENTATION: We are presenting a 50 years old woman presented to the hospital with sudden acute severe abdominal pain and distension of about 24 hours associated with vomiting and no flatus. CONCLUSION: Mortality in patients with CV can be kept near 10%-12% if operative intervention is accomplished before caecum strangulation. Once the cecum has become gangrenous, a death rate of 30 to 40% can be expected. Tailored made surgery on patients status is the strategy.

scholarly journals Endoscopic Submucosal Dissection of Pseudo-polyps in the Right Colon Using a Flexible Grasper With Articulating Distal Tip and Elbow-Like Bending

2021 ◽  
Author(s):  
Shinya Urakawa ◽  
Teijiro Hirashita ◽  
Yuka Hirashita ◽  
Lea Lowenfeld ◽  
Krishna Gurram ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
3D Model ◽  
Posterior Wall ◽  
Ascending Colon ◽  
Procedure Time ◽  
Right Colon ◽  
Submucosal Dissection ◽  
Descending Colon ◽  
The Right ◽  
Surgical Platform

Abstract Endoscopic submucosal dissection (ESD) is challenging in the right colon. Traction devices can make it technically easier. In this study, we evaluated a flexible grasper with articulating tip and elbow-like bending (IgE) through a double-balloon surgical platform (DESP), compared with an earlier generation grasper without elbow-like bending (Ig). The reach of Ig/IgE was investigated at eight locations using a synthetic colon within a 3D model. Using a fresh porcine colorectum, 4 cm pseudo-polyps were created at the posterior wall of the ascending colon. Fifty-four ESD procedures were performed using three techniques: standard ESD (STD), ESD using Ig (DESP+Ig), and ESD using IgE (DESP+IgE). IgE was able to reach the full circumference at all the locations, whereas the medial walls proximal to the descending colon were out of Ig’s reach. Compared with the STD, both DESP+Ig and DESP+IgE showed significantly shorter procedure time (STD vs. DESP+Ig vs. DESP+IgE = median 48.9 min vs. 38.6 vs. 29.9) and fewer injuries (1.5 vs. 0 vs. 0). Moreover, the DESP+IgE had a shorter procedure time than the DESP+Ig (p=0.0025). The IgE with DESP increased instrument reach compared to Ig, and likely represented a traction tool for excision of large pseudo-polyps in the right colon.

Ischemic Conditioning in the Right Colon and Terminal Ileum: An Experimental Rat Model

2021 ◽  
Author(s):  
Gerardo Rodriguez-Leon ◽  
Fernando Estremiana ◽  
Monica Miro ◽  
Carla Bettonica ◽  
Humberto Aranda ◽  
...  
Keyword(s):  
Rat Model ◽  
Terminal Ileum ◽  
Sham Group ◽  
Esophageal Replacement ◽  
Adaptive Mechanism ◽  
Right Colon ◽  
Ischemic Conditioning ◽  
Histological Damage ◽  
Submucosal Vessel ◽  
The Right

Introduction: Preoperative gastric ischemic conditioning (IC) improves the outcome of esophageal replacement gastroplasty and is associated with low morbidity. However, when the stomach cannot be used for esophageal replacement, a colonic replacement is required. The study aim was to assess the viability of right colon and terminal ileum IC in a rat model, the histological damage/recovery sequence, and determine if neovascularization is a potential adaptive mechanism. Methods: The study was conducted in Rattus norvegicus with ileocolic vascular ligation. Seven groups of animals were established (six rats per group) with groups defined by the date of their post-IC euthanasia (+1, +3, +6, +10, +15, and +21 days). Comparisons were made with a sham group. Viability of the model was defined as <10% of transmural necrosis. The evaluation of histological damage used the Chiu score in hematoxylin and eosin sections of paraffin-embedded specimens with CD31 immunohistochemical assessment of neovascularization by the median of submucosal vessel counts in five high-magnification fields. Results: Transmural colon necrosis occurred in 1/36 animals (2.78%) with no animal demonstrating transmural ileal necrosis. The maximum damage was observed in the colon on +1 day post-IC (average Chiu score 1.67, P = 0.015), whereas in the ileum, it was on days +1, +3, and +6 (average Chiu score 1.5, 1.3, and 1.17; P = 0.015, 0.002, and 0.015, respectively). In the +21-day group, histological recovery was complete in the colon in four (66.7%) of the six animals and in the ileum in five (83.3%) of six animals. There were no significant differences in quantitative neovascularization in any of the groups when compared with the sham group or when comparisons were made between groups. Conclusions: The tested animal model for IC of the colon and terminal ileum appeared to be feasible. Histological damage was maximal between the 1st and 3rd day following IC, but by day 21, recovery was complete in two-thirds of the rats. There was no evidence in this preliminary IC model that would suggest neovascularization as an adaptive mechanism.

scholarly journals Efficacy of infliximab treatment on the mucosal healing of different intestinal segments in patients with ileocolonic Crohn’s disease

2020 ◽  
Vol 13 ◽  
pp. 175628482097692
Author(s):  
Yaling Wu ◽  
Lei Zhang ◽  
Jingli Cao ◽  
Haichao Wang ◽  
Chen Ye ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Terminal Ileum ◽  
Transverse Colon ◽  
Mucosal Healing ◽  
Treat To Target ◽  
Infliximab Treatment ◽  
Right Colon ◽  
Single Center Study ◽  
The Right

Background: Mucosal healing (MH) is the key aim of the treat-to-target strategy for patients with Crohn’s disease (CD). The efficacy of infliximab (IFX) on MH in different ileocolonic segments is unclear. The aim of this study was to investigate endoscopic MH in different ileocolonic segments in patients with CD who received IFX treatment. Methods: A retrospective, single-center study was performed in patients with active ileocolonic CD between January 2012 and December 2018. All patients underwent IFX treatment for at least 30 weeks. The MH of five ileocolonic segments was assessed by the Simple Endoscopic Score for CD (SES-CD) at baseline, 14/22 weeks and 30/38 weeks. The SES-CD values were analyzed by a mixed-effects model after the correction for confounding factors. Results: A total of 101 eligible patients were included. The baseline endoscopic severity was similar across segments. At 30/38 weeks, the greatest changes in the SES-CD ulcer size and ulcerated surface subscores were −94.29% and −94.32% both in the transverse colon ( p < 0.0001), and the smallest changes were −67.88% and −69.67% both in the terminal ileum ( p < 0.0001) compared with baseline. Stenosis mainly presented in the right colon (12/29, 41.38%). The change in the SES-CD stenosis subscore was −6.25% in the right colon at 30/38 weeks compared with −71.88% at 14/22 weeks ( p = 0.0030). At 30/38 weeks, the transverse colon achieved the highest rate of complete MH (CMH) at 81.2%, and the lowest CMH rate occurred in the terminal ileum at 45.6%. Moreover, the degree of improvement in the rectum was negatively correlated with disease progression ( p = 0.011). Conclusions: Ileocolonic segments in CD presented different degrees of endoscopic MH during IFX treatment. The transverse colon showed the highest CMH rate, whereas the right colon with stenosis showed the poorest improvement. The differing propensities of ileocolonic segments may provide an individualized IFX treatment strategy.

scholarly journals Pneumatosis intestinalis in COVID-19

2020 ◽  
Vol 7 (1) ◽  
pp. e000434 ◽  
Author(s):  
Simone Meini ◽  
Chiara Zini ◽  
Maria Teresa Passaleva ◽  
Anna Frullini ◽  
Francesca Fusco ◽  
...  
Keyword(s):  
Pneumatosis Intestinalis ◽  
Respiratory Illness ◽  
Gi Tract ◽  
Right Colon ◽  
Case Presentation ◽  
Gi Symptoms ◽  
The Right ◽  
Cytomegalovirus Infections

IntroductionCOVID-19 is a respiratory illness due to novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), described in December 2019 in Wuhan (China) and rapidly evolved into a pandemic. Gastrointestinal (GI) tract can also be involved.Case presentationA 44-year-old man was hospitalised for COVID-19-associated pneumonia. A rapid recovery of respiratory and general symptoms was observed after 1 week of treatment with lopinavir/ritonavir plus hydroxychloroquine and broad-spectrum antibiotics (piperacillin–tazobactam plus teicoplanin). No GI symptoms were reported during hospitalisation, but a lung contrast-enhancement CT (CE-CT) excluding thromboembolism showed, as collateral finding, intraperitoneal free bubbles not present on a previous CT examination; the subsequent abdominal CE-CT described pneumatosis intestinalis (PI) involving the caecum and the right colon. Ciprofloxacin plus metronidazole was started, and the 2-week follow-up CT showed the complete resolution of PI.DiscussionThe pathogenesis of PI is poorly understood. PI involving the caecum and right colon has been described for HIV and Cytomegalovirus infections, but, to our best knowledge, never before in COVID-19. We hypothesise a multifactorial aetiopathogenesis for PI, with a possible role of the bowel wall damage and microbiota impairment due to SARS-CoV-2 infection, and we suggest a conservative management in the absence of symptoms.

scholarly journals Use of an endoscopic flexible grasper as a traction tool for excision of polyps: preclinical trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinya Urakawa ◽  
Teijiro Hirashita ◽  
Yuka Hirashita ◽  
Lea Lowenfeld ◽  
Krishna C. Gurram ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
3D Model ◽  
Posterior Wall ◽  
Ascending Colon ◽  
Procedure Time ◽  
Right Colon ◽  
Preclinical Trial ◽  
Descending Colon ◽  
The Right ◽  
Surgical Platform

AbstractEndoscopic submucosal dissection (ESD) is challenging in the right colon. Traction devices can make it technically easier. In this study, we evaluated a flexible grasper with articulating tip and elbow-like bending (IgE) through a double-balloon surgical platform (DESP), compared with an earlier generation grasper without elbow-like bending (Ig). The reach of Ig/IgE was investigated at eight locations using a synthetic colon within a 3D model. Using a fresh porcine colorectum, 4 cm pseudo-polyps were created at the posterior wall of the ascending colon. Fifty-four ESD procedures were performed using three techniques: standard ESD (STD), ESD using Ig (DESP + Ig), and ESD using IgE (DESP + IgE). IgE was able to reach the full circumference at all the locations, whereas the medial walls proximal to the descending colon were out of Ig’s reach. Compared with the STD, both DESP + Ig and DESP + IgE showed significantly shorter procedure time (STD vs. DESP + Ig vs. DESP + IgE = median 48.9 min vs. 38.6 vs. 29.9) and fewer injuries (1.5 vs. 0 vs. 0). Moreover, the DESP + IgE had a shorter procedure time than the DESP + Ig (p = 0.0025). The IgE with DESP increased instrument reach compared to Ig, and likely represented a traction tool for excision of large pseudo-polyps in the right colon.

scholarly journals The First Report of an Intraperitoneal Free-Floating Mass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Ibrahim Uygun ◽  
Bahattin Aydogdu ◽  
Mehmet Hanifi Okur ◽  
Selcuk Otcu
Keyword(s):  
Small Intestine ◽  
Acute Abdomen ◽  
Terminal Ileum ◽  
Signs And Symptoms ◽  
Pathological Examination ◽  
Necrotic Tissue ◽  
First Case ◽  
The Right ◽  
Almost All ◽  
Thin Band

A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen.

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