Laboratory examination showing lymphopenia, hypoalbuminemia, hypogammaglobulinemia suggested the diagnosis of primary intestinal lymphangiectasia. Gastroscopy was normal and second duodenum biopsies were negative. Videocapsule endoscopy gave evidence of intestinal lymphangiectasia of the small bowel. Videocapsule endoscopy may be proposed to confirm intestinal lymphangiectasia and to precise their localization when gastroscopy is not conclusive.
Is isomerism a risk factor for intestinal volvulus? Isomerism, or heterotaxy syndrome, affects many organ systems anatomically and functionally. Intestinal malrotation is common in patients with isomerism. Despite a low reported risk of volvulus, some physicians perform routine screening and prophylactic Ladd procedures on asymptomatic patients with isomerism who are found to have intestinal malrotation.
The primary aim of this study was to determine if isomerism is an independent risk factor for volvulus. Kid's Inpatient Database data from to was utilized for this study. Characteristics of admissions with and without isomerism were compared with a particular focus on intestinal malrotation , volvulus, and Ladd procedure. A logistic regression was conducted to determine independent risk factors for volvulus with respect to isomerism.
Isomerism was associated with a fold increase in the odds of intestinal malrotation by univariate analysis. Of with isomerism and intestinal malrotation , only 2. Logistic regression demonstrated that isomerism was not an independent risk factor for volvulus. Isomerism is associated with an increased risk of intestinal malrotation but is not an independent risk factor for volvulus.
Prognosis study. Level III. Primary small intestinal volvulus after laparoscopic rectopexy for rectal prolapse. Primary small intestinal volvulus is defined as torsion in the absence of congenital malrotation , band, or postoperative adhesions.
Its occurrence as an early postoperative complication is rare. A year-old woman presented with rectal prolapse, and laparoscopic rectopexy was uneventfully performed. She could not have food on the day after surgery. She started oral intake on postoperative day 3 but developed abdominal pain after the meal.
Contrast-enhanced CT revealed torsion of the small intestinal mesentery. An emergent laparotomy showed small intestinal volvulus, without congenital malformation or intestinal adhesions. We diagnosed it as primary small intestinal volvulus. The strangulated intestine was resected, and reconstruction was performed. The patient recovered uneventfully after the second surgery.
To the best of our knowledge, this is the first report of primary small intestinal volvulus occurring after rectopexy for rectal prolapse. Primary small intestinal volvulus could be a postoperative complication after laparoscopy. Primary intestinal lymphangiectasia: A rare cause of diarrhea in adults diagnosed by capsule endoscopy and double balloon enteroscopy. The etiology and prevalence of PIL remain unknown. Small bowel imaging modalities like capsule endoscopy and double balloon enteroscopy have increased the chances of diagnosis of PIL due to direct visualization of small bowel.
Diagnosis is confirmed by characteristic histopathological finding, which includes dilated intestinal lymphatics with broadened villi of the small bowel. We report a case of a patient with chronic diarrhea who was extensively worked up before he was finally diagnosed to have PIL involving the small bowel by performing balloon enteroscopy-guided biopsy. Malignant lymphoma incidentally diagnosed due to the perforation of the small intestine caused by a fish bone: A case report.
Full Text Available Introduction: The ingestion of a foreign body is relatively common. However, it rarely results in the perforation of gastrointestinal tract. We herein report an unusual case of malignant lymphoma incidentally diagnosed after the perforation of the small intestine by a fish bone. Presentation of case: A year-old woman was admitted to our hospital because of abdominal pain and vomiting.
Abdominal computed tomography demonstrated free air and ascites in the abdominal cavity. Therefore, a diagnosis of perforation of the small intestine due to ingestion of a foreign body and panperitonitis was made. Emergent laparotomy was performed.
The intraoperative findings revealed perforation of the small intestine with a fish bone in the jejunum. Local inflammation at the perforation site was seen, and circulated wall thickness was observed at the distal side of the jejunum. Partial resection of the jejunum and anastomosis of jejuno-jejunostomy was performed. A pathological examination and immunohistochemical study of the resected specimen resulted in a diagnosis of malignant lymphoma of follicular lymphoma Grade 1.
Discussion: It is very difficult to identify the existence malignancy accompanied with gastrointestinal perforation with ingestion of a foreign body. Conclusion: In cases suspected of involving malignancy, careful observation during surgery is needed in order to avoid missing the accompanying malignancy. The incidence of symptomatic malrotation post gastroschisis repair. Gastroschisis is known to be associated with abnormal bowel rotation. However the incidence of symptomatic malrotation and volvulus post gastroschisis repair is unknown; this incidence is important in view of the current practice of bedside gastroschisis closure.
This study examined the incidence of symptomatic malrotation and volvulus following gastroschisis repair. Malrotation with midgut volvulus associated with perforated ileal duplication. Full Text Available Duplication of the alimentary tract is an important surgical condition. It may occur anywhere in the gastrointestinal tract. An important complication of this entity is perforation of the normal or abnormal gut.
Malrotation with midgut volvulus can be a surgical emergency. We present a patient, who presented as malrotation with midgut volvulus associated with perforated ileal duplication. The patient was successfully managed. The value of digital subtraction angiography in diagnosing small intestinal hemorrhage with unknown reasons. Objective: To discuss the diagnostic value of DSA for unknown reason hemorrhage of small intestine. Methods: 25 patients with hemorrhage of small intestine were performed angiography with Seldinger's technique through superior mesenteric artery.
Results: Eleven cases demonstrated direct signs of hemorrhage, 12 cases of indirect signs of hemorrhage and 5 with both of the signs. Conclusions: DSA angiography is very helpful for determining the location and character of unknown reason hemorrhage of small intestine. Primary intestinal lymphangiectasia diagnosed by capsule endoscopy and double balloon enteroscopy. Primary intestinal lymphangiectasia PIL is a rare disorder characterized by dilated intestinal lymphatics and the development of protein-losing enteropathy.
Patients with PIL develop hypoalbuminemia, hypocalcemia, lymphopenia and hypogammaglobulinemia, and present with bilateral lower limb edema, fatigue, abdominal pain and diarrhea. Endoscopy reveals diffusely elongated, circumferential and polypoid mucosae covered with whitish enlarged villi, all of which indicate intestinal lymphangiectasia.
Diagnosis is confirmed by characteristic tissue pathology, which includes dilated intestinal lymphatics with diffusely swollen mucosa and enlarged villi. The prevalence of PIL has increased since the introduction of capsule endoscopy. Some studies have reported that several genes and regulatory molecules for lymphangiogenesis are related to PIL.
We report the case of a patient with PIL involving the entire small bowel that was confirmed by capsule endoscopy and double-balloon enteroscopy-guided tissue pathology who carried a deletion on chromosome 4q The relationship between this deletion on chromosome 4 and PIL remains to be investigated. Adult midgut volvulus is a challenging diagnosis because of its low incidence and nonspecific symptoms.
Diagnostic delay and long-term complaints are frequent in this clinical scenario. We reported a patient referred to our diagnostic imaging unit with intermittent abdominal pain, bloating and episodic vomiting for several years. He underwent barium gastrointestinal transit and abdominal ultrasound, which revealed severe gastric dilatation, food retention and slow transit until a depressed duodenojejunal flexure, with malrotation of the midgut and jejunal loops being located in the right upper quadrant.
Computed tomography angiography was performed, showing rotation of the small intestine around the mesentery root, suggestive of midgut malrotation. In addition, an abnormal twisted disposition of superior mesenteric artery with corkscrew appearance was seen, shaping the pole-barber sign which was evident in volume rendering three-dimensional reconstructions.
The patient underwent scheduled surgical treatment without any complication and had good outcome after hospital discharge and follow-up. Computed tomography plays an important role in evaluation of adult midgut volvulus. In addition, angiographic reconstructions can help us to assess the anatomic disposition of mesenteric vascular supply.
Both of these assessments are useful in preoperative management. Malrotation discovered during routine radionuclide gastric emptying study. Kovanlikaya, A. In infants with recurrent vomiting, and especially bilious vomiting, the algorithmic approaches is to perform conventional barium upper gastrointestinal radiography to rule out malrotation and midgut volvulus, which are surgical emergencies.
However, children with protracted vomiting and failure to thrive are candidates for medical treatment. These children are often evaluated by radionuclide gastric emptying studies to assess gastric emptying. Three patients are presented in whom the radionclude gastric emptying study revealed the presence of a malrotation anomaly which had been undetected by antecedent barium gastrointestinal radiographic studies.
Fetal midgut volvulus is quite rare, and most cases are associated with abnormalities of intestinal rotation or fixation. We report a case of midgut volvulus without malrotation , associated with a meconium pellet, during the gestation period.
This 2. This patient had an unusual presentation with a distended abdomen showing skin discoloration. An emergency laparotomy revealed a midgut volvulus and a twisted small bowel, caused by complicated meconium ileus. Such nonspecific prenatal radiological signs and a low index of suspicion of a volvulus during gestation might delay appropriate surgical management and result in ischemic necrosis of the bowel.
Preterm labor, specific prenatal sonographic findings for example, the coffee bean sign and bluish discoloration of the abdominal wall could suggest intrauterine midgut volvulus requiring prompt surgical intervention. Abstract Introduction Primary intestinal lymphangiectasia is a disorder characterized by exudative enteropathy resulting from morphologic abnormalities of the intestinal lymphatics. A double-balloon enteroscopy and biopsy, as well as the pathology can be used to confirm the diagnosis of intestinal lymphang The stepchild of intestinal diagnostics.
Evaluation of radiological methods to diagnose leiomyomas of the small bowel. Purpose: Various radiological methods to diagnose small bowel neoplasmas and problems of differential diagnosis specially considerating leiomyomas are discussed. Patients and methods: Two patients with leiomyoma of the ileum underwent enteroclysis, computed tomography of the abdomen, intra-arterial DSA and colour Doppler sonography.
Another patient with leiomyosarcoma just underwent CT of the abdomen with CT-guided biopsy. Results: Due to the homogenous density and the smooth surface of the tumors in computed tomography and respectively enteroclysis and the presentation of the tumor vascularisation in the angiography and Colour Doppler sonography in both patients a leiomyoma of the small bowel was diagnosed. Postoperatively this diagnosis was histologically confirmed.
The CT-findings of the patient with leiomyosarcoma were not suspicious of a malignant tumor. Conclusion: Radiologically it is not possible to determine the dignity of smooth muscle cell tumors safely. That is the reason why the diagnosis has to be achieved operatively. But the histopathological diagnosis based on the mitotic rate may be difficult. Therefore the after care has to be carried out thoroughly. Superior mesenteric vein rotation: a CT sign of midgut malrotation. Computed tomography CT of the pancreas, with its excellent display of peripancreatic anatomy, allows visualization of the major vessels entering the mesenteric root.
In scans of the normal upper abdomen obtained at or just below the level of the uncinate process of the pancreas, the proximal superior mesenteric vein SMV easily can be identified lying on the right ventral aspect of the superior mesenteric artery SMA. The authors have observed a characteristic abnormality in this normal vascular arrangement on CT scans of the pancreas in three adult patients with suspected chronic pancreatitis who were subsequently proved to have midgut malrotation.
They called this the SMV rotation sign and believe that its detection even on CT scans limited to the level of the pancreas should alert the radiologist to the presence of a midgut malrotation that may have been unsuspected. Vascular compromise in chronic volvulus with midgut malrotation. Three cases of chornic volvulus of the small bowel in midgut malrotation are presented, all of whom manifested similar angiographic findings: proximal occlusion of the superior mesenteric artery and vein and development of collateral vessels.
These findings may indicate the pathophysiology of chronic volvulus in midgut malrotation ; the volvulus is progressive and eventually results in the twisting of the mesenteric root itself, but because of its chronic nature collateral circulation develops, eliminating bowel necrosis. Computed tomography CT , performed in two cases, revealed dilated, tortuous vessels in the mesentery in addition to the known CT finding of a whirl-like pattern of the volvulated small bowel loops.
Sonography, performed in one case, showed an unique feature of whirling sonolucent layers probably representing the volvulated small bowel loops intermixed with dilated mesenteric collateral vessels. We would like to emphasize the usefulness of CT and sonography in the early diagnosis of those cases with vague and nonspecific clinical manifestations.
Currarino triad associated with malrotation of the colon. Currarino triad is a rare congenital condition characterized by a sacral bony defect, presacral mass, and anorectal malformations. We describe an unusual case of complete Currarino triad in a year-old female with sacral bony defect, anal stenosis, recto-vaginal fistula, and dual pathology meningocele and teratoma in the pre sacral mass associated with malrotation of the colon.
This combination has not been reported previously. The clinical presentation, surgical management and review of literature are discussed. Daoud, Fajez S [Dept. The paper present the diagnosic sensitivit of gastro esophagic scintigraphy GCE in children with suspiction of gastro esophagic reflux RGE , as well as to evidence bronchial aspiratin in cases with suspected RGE.
There was studied two groups of children: group A: Include 73 childs with documented diagnosis of RGE, by meas of cine esophagography. Group B: Include 22 children with symptoms of suspiction of. The author. Laparoscopic diagnosis of magnetic malrotation with fistula and volvulus. Most foreign bodies that a child ingests pass harmlessly through the gastrointestinal tract. However, ingesting multiple magnets places a child at risk for serious viscus injury.
A y-old boy swallowed multiple magnets and presented with abdominal pain and emesis. Upon laparoscopy, the boy was found to have malrotation with volvulus caused by a cecal magnet attracted to a gastric magnet, resulting in a gastrocecal fistula. We review the management of magnet ingestion with an emphasis on a high index of suspicion and the use of laparoscopy for diagnosis, as well as the consequences of a coexisting rotational anomaly.
Malrotation volvulus in a neonate: a novel surgical approach. A newborn presented with bilious vomiting secondary to a malrotation and presumed perinatal-onset volvulus. Laparotomy was performed at 20 h of age at which the volvulus was derotated. Nevertheless the small but not the large bowel appeared to be completely ischaemic and non-viable.
A second-look laparotomy was performed 24 h later with no significant improvement. In a new approach to the problem, nothing further was done and the child was left alone on parenteral nutrition and naso-gastric aspiration for 11 weeks. Further exploration showed that 40 cm of small bowel had survived intact and restorative surgery was carried out. Parenteral nutrition was discontinued after 9 months and the child, now aged 3.
Case report of primary intestinal lymphangiectasia diagnosed in an octogenarian by ileal intubation and by push enteroscopy after missed diagnosis by standard colonoscopy and EGD. Primary intestinal lymphangiectasia PIL is a rare, presumably congenital lesion that is usually diagnosed in patients lymphangiectasia.
PIL was diagnosed after excluding secondary causes of intestinal lymphangiectasia. Patient placed on standard PIL diet: oral supplements of medium-chain triglycerides, a high protein diet, supplements of fat-soluble vitamins, and avoiding long-chain fatty acids, with marked clinical improvement. Published by Wolters Kluwer Health, Inc. Full Text Available Celiac disease CD is a chronic small intestinal enteropathy triggered by gluten in genetically predisposed individuals.
The susceptibility is strongly associated with certain human leukocyte antigen HLA-genes, but efforts are being made in trying to find non-HLA genes that are predictive for the disease. The criteria for diagnosing CD were previously based primarily on histologic evaluation of small intestinal biopsies, but nowadays are often based only on blood tests and symptoms. In this context, we elucidated the accuracy of three diagnostic indicators for CD, alone or in combination.
CD was confirmed in children, while 68 were considered non-celiacs. The single best predictors were antibodies i. The nine SNPs used did not contribute to the right diagnoses. Intestinal Surgery. A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus.
Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Midgut volvulus: a rare cause of episodes of intestinal obstruction in an adult.
Midgut volvulus occurs frequently in infants and children, but is uncommon in adults. We present a case of intestinal malrotation complicated by midgut volvulus in a young woman who complained of chronic intermittent abdominal pain of increasing intensity. The radiologies diagnosis was based mainly on upper gastrointestinal barium study, and was confirmed intraoperatively. Author 11 refs. Incidence of clinically silent malrotation detected on barium swallow examination in children.
Duodenojejunal flexure DJF orientation is often examined routinely during contrast swallow studies, including those performed for purely oesophageal queries. We examine the radiation burden and the incidence of malrotation in patients undergoing contrast swallow, without clinical suspicion for malrotation. Two hundred eighteen consecutive contrast swallow studies were reviewed. Data extracted include demographics, radiographic parameters dosage, screening time, number of images obtained and examination findings.
Malrotation was identified in 2 of 90 patients 2. This study highlights the increased radiation exposures involved with routine screening for DJF position in those patients without clinical suspicion of malrotation , and raises questions about the validity of this practice; however, further research is needed. Dogs may be affected by different species of gastrointestinal parasites which present great importance in veterinary medicine and public health.
Several techniques to diagnosing these parasites have been proposed, but different performances achieved by each method make difficult the choice of the best technique to be used. In this study, the performance of two classic methods i. Ancylostomatidae, Trichuris vulpis and Toxocara canis were the most frequent parasites herein detected. This study is the first report of the use of both techniques i.
Postoperative malrotation of humeral shaft fracture after plating compared with intramedullary nailing. We supposed difference of rotation alignment of postoperative humeral shaft fracutres between open reduction and internal fixation ORIF and intramedullay nailing IMN could be identified and the difference might influence the involved shoulder.
This study evaluated and compared the extent of malrotation and shoulder function after humeral shaft fractures treated operatively with IMN or ORIF. Fifty humeral shaft fractures were randomly allocated into 2 groups. Malrotation was measured postoperatively by computed tomography scan CT. Fracture union and functional outcomes were recorded at 12 months. The final analysis comprised 45 patients.
Group I had lower functional scores than group II P shaft fracture. The study can provide baseline data for larger series and longer follow-up periods. Patients who underwent IMN had lower functional scores and a decreased range of motion postoperatively and also had a greater degree of malrotation than the ORIF group, which had none.
The degree of malrotation correlated with a decreased range of motion and may possibly be a reason for degenerative arthritis at long-term follow-up. Published by Mosby, Inc. Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures. Most of the methods that provide rotational control during surgery are based on a comparison to the intact femur and, thus, not applicable for bilateral fractures.
In this study, we evaluated if preoperative virtual reduction can help improving rotational alignment in patients with bilateral femoral shaft fractures. Seven patients with bilateral femoral shaft fractures were initially treated with external fixation of both femurs.
Subsequently, the patients were treated by antegrade femoral nailing and rotation was corrected to the preoperatively calculated amount. After external fixation, the mean rotational difference between both legs was Following virtual reduction, the mean rotational difference between both legs was 2. After intramedullary nailing, no case of malrotation occurred and the mean rotational difference was 6. Preoperative virtual reduction allows determining the pretraumatic femoral antetorsion and provided useful information for the definitive treatment of bilateral femoral shaft fractures.
We believe that this procedure is worth being implemented in the clinical workflow to avoid malrotation after intramedullary nailing. A case of right ectopic kidney associated with malrotation of left kidney. The terms 'renal ectopia' describes kidneys which are congenitally located in abnormal anatomic positions.
I have experienced a female patient with right ectopic kidney located in lower abdomen and pelvis associated with hydronephrosis and chronic pyelonephritis. Her left kidney showed malrotation. This case was reported with review of literatures. Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Lampl, Brooke; Berdon, Walter E. The complex and sometimes controversial subject of malrotation and midgut volvulus is reviewed commencing with the 19th-century Bohemian anatomist, Vaclav Treitz, who described the suspensory muscle anchoring of the duodenal-jejunal junction in the left upper quadrant, and continuing with William Ladd, the 20th-century American ''father of pediatric surgery'' who pioneered the surgical treatment of midgut volvulus.
In this review, we present the interesting history of malrotation and discuss the current radiologic and surgical controversies surrounding its diagnosis and treatment. In the symptomatic patient with malrotation and possible midgut volvulus, prompt diagnosis is critical.
The clinical examination and plain film are often confusing, and delayed diagnosis can lead to significant morbidity and death. Despite recent intense interest in the position of the mesenteric vessels on US and CT scans, the upper gastrointestinal series remains the fastest and most accurate method of demonstrating duodenal obstruction, the position of the ligament of Treitz, and, if the contrast agent is followed distally, cecal malposition.
Controversy exists over the management of asymptomatic patients with malrotation in whom the diagnosis is made incidentally during evaluation for nonspecific complaints, prior to reflux surgery, and in those with heterotaxy syndromes. Megacystis-microlon- intestinal hypoperistalsis syndrome in a newborn girl whose brother had Prune Belly syndrome: Common Pathogenesis. After a review of the literature, many common characteristics of MMIHS and PBS are described: flaccid abdomen, dilatation of the urinary tract, intestinal malrotation , cryptorchidism, urachal remnants and familial incidence.
Intestinal volvulus: aetiology, morbidity and mortality in Tunisian children. Intestinal volvulus IV can occur at various sites of the gastrointestinal tract. In Europe, IV in children is most frequently due to malrotation but in Asia Ascaris infestation is a common cause. This report reviews the experience with IV in children in Tunisia; analyzes the aetiologies as well as the clinical presentations and the benefits of the Ladd's procedure in the treatment of the IV.
The authors retrospectively reviewed the case records of all children with IV from January to December at the Tunis Children's Hospital. There were 22 boys and nine girls with an age range of one day to four years. The most common presentation was bilious vomiting and dehydration.
All patients with malrotation had Ladd's procedure performed. One patient presented with adhesive small bowel obstruction. There were no recurrences following Ladd's procedure for malrotation. Intestinal volvulus in our environment differs in aetiology from other reports.
The resection rates are not similar, however. Early diagnosis reduced the high morbidity and mortality in our study. Midgut volvulus: a rare cause of episodes of intestinal obstruction in an adult; Volvulo de intestino medio: una rara causa de crisis oclusivas en el adulto. Palomo, V. Jaen Spain. Meurs, Lynn; Polderman, Anton M. Background: Many different intestinal parasite species can co-occur in the same population.
However, classic diagnostic tools can only frame a particular group of intestinal parasite species. Hence, one or two tests do not suffice to provide a complete picture of infecting parasite species in a. Meurs Lynn ; A. Polderman A. Vinkeles Melchers Natalie ; E. Brienen Eric ; J. Verweij Jaco ; B. Groosjohan Bernhard ; F. Mendes Felisberto ; M. Mechendura Manito ; D. Hepp Dagmar H. Langenberg Marijke C. Edelenbosch Rosanne ; K. Polman Katja ; L. Hence, one or two tests do not suffice to provide a complete picture of infecting.
Variations of structure and position of the kidney along with variations of renal vessels are most frequently reported. Rotational variations form a rare entity that are not cited in most embryology textbooks. During an educational cadaveric dissection of a year-old male, a complex picture of bilateral anatomical variants was encountered. Malrotation of both kidneys and a left lobulated ectopic kidney along with open hilum was observed.
The left kidney showed a pelvic position in front of Sonographic diagnosis of fetal intestinal volvulus with ileal atresia: a case report. Fetal intestinal volvulus is a rare life-threatening condition usually manifesting after birth with most cases being associated with intestinal malrotation.
It appears on prenatal sonography US as a twisting of the bowel loops around the mesenteric artery, leading to mechanical obstruction and ischemic necrosis of the bowel. We report a case of intrauterine intestinal volvulus with ileal atresia, suspected when US revealed a typical "whirlpool" sign at 37 weeks' gestation, with a segment of markedly distended bowel loops and small amount of fetal ascites.
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