MyMedR

Antenatal diagnosis and management of foetal intestinal volvulus

Yip KW, Cheng YKY, Leung TY

Med J Malaysia, 2017 04;72(2):126-127.

In-utero intestinal volvulus is a rare but potential life threatening foetal complications. It is a surgical emergency and delay in diagnosis or treatment can increase the morbidity and mortality to the foetus. We report a case of mild foetal bowel dilatation diagnosed at 21 weeks of gestation. She was closely follow up and at 31 weeks of gestation, in-utero intestinal volvulus was diagnosed with the characteristic 'whirlpool' sign on ultrasound examination. This case emphasises the importance of early recognition and quick decision to delivery when intestinal volvulus is diagnosed. This enabled early surgical intervention to prevent further foetal morbidity.

Matched MeSH terms: Intestinal Volvulus/diagnosis; Intestinal Volvulus/embryology*; Intestinal Volvulus/surgery

Caecal Volvulus after a dental procedure - not just constipation!

Ng ZQ, Tan JH, Tan H

Malays Fam Physician, 2019;14(2):32-35.

PMID: 31827734

Caecal volvulus has been reported to be associated with various abdominal and pelvic pathologies. Its signs and symptoms are usually non-specific and maybe overlooked in favour of benign causes, such as constipation. A high degree of suspicion is required for prompt diagnosis. Herein, we report on an unusual case of caecal volvulus after a dental procedure that was managed initially as constipation.

Matched MeSH terms: Intestinal Volvulus

A fatal twist in childhood: A post-mortem finding of intestinal volvulus with malrotation

Tan RZ, Darwin FL, Anuar Zainun K

Malays J Pathol, 2020 Dec;42(3):477-481.

PMID: 33361732

Gastrointestinal pathology leading to the death in paediatric age group is uncommon. The diseases that encountered were mostly intestinal obstruction, peritonitis and gastrointestinal bleeding. Due to the severe symptoms, most of the patients presented to hospital in time and were treated appropriately. However, with the presence of contributing factors, certain gastrointestinal pathology can progress rapidly leading to the death. We report a rare case of intestinal volvulus in a 3 years old girl where the deceased presented with one day short history of vomiting before her demise. The contributing factors were bronchopneumonia sepsis and underlying intestinal malrotation identified via post-mortem examination.

Matched MeSH terms: Intestinal Volvulus/congenital*

A case of volvulus of stomach complicating left phrenic interruption and left lower lobectomy

YOUNG CK

Med J Malaya, 1957 Sep;12(1):384-5.

PMID: 13492810

Matched MeSH terms: Intestinal Volvulus*

Fulltext A case of closed loop small bowel obstruction within a strangulated incisional hernia in association with an acute gastric volvulus

Kosai NR, Gendeh HS, Noorharisman M, Sutton PA, Das S

Acta Medica (Hradec Kralove), 2014;57(2):83-6.

PMID: 25257156 DOI: 10.14712/18059694.2014.45

Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.

Matched MeSH terms: Intestinal Volvulus/etiology*; Intestinal Volvulus/radiography; Intestinal Volvulus/surgery

Duplication cyst with midgut volvulus in a neonate: an unusual presentation

Pai NG, Prabhu S, Prabhakar P, Kumar V

BMJ Case Rep, 2020 Aug 26;13(8).

PMID: 32847882 DOI: 10.1136/bcr-2020-235526

Incomplete intestinal fixation or malrotation of gut with midgut volvulus is one of the important causes of bilious vomiting in neonates. The incidence of malrotation of gut in population is 4% and that of duplication cyst is 1:4500. Patients with malrotation are prone to develop midgut volvulus due to their narrow mesenteric base demanding urgent surgical intervention. Common associated anomalies are intrinsic duodenal obstruction, internal hernias, caecal volvulus, anorectal malformations and Hirschsprung's disease. The present case refers to a 4-day-old neonate who presented with malrotation of gut with reverse volvulus and an associated gastrointestinal duplication cyst, which is a rare association with only few reported case reports. After imaging with ultrasound and contrast radiograph, the baby underwent prompt surgical intervention in the form of Ladd's procedure with resection and anastomosis of jejunal duplication cyst.

Matched MeSH terms: Intestinal Volvulus/complications; Intestinal Volvulus/diagnosis*; Intestinal Volvulus/surgery

Total jejuno-ileal volvulus with jejunal diverticulosis

Vine LE

Journal of the Malaya Branch of the British Medical Association, 1941;5:58-9.

Matched MeSH terms: Intestinal Volvulus

Fulltext Midgut malrotation with congenital peritoneal band: a rare cause of small bowel obstruction in adulthood

Low SF, Ngiu CS, Sridharan R, Lee YL

BMJ Case Rep, 2014;2014.

PMID: 24717859 DOI: 10.1136/bcr-2013-202690

Midgut malrotation commonly presents in the neonatal period, and rarely manifests its symptoms in adulthood with an estimated incidence of 0.2-0.5%. Nevertheless, the symptoms are non-specific with no strong pointers towards the clinical diagnosis. Consequently, the diagnosis is usually disclosed with imaging or surgery. We report a case of small bowel obstruction secondary to a congenital peritoneal band with underlying midgut malrotation in a 48-year-old man.

Matched MeSH terms: Intestinal Volvulus/complications*; Intestinal Volvulus/congenital

Fulltext Anomalous peritoneal band connecting greater omentum to the ascending colon: a possible cause for dilation of ascending colon

Nayak SB, Soumya KV

Anat Cell Biol, 2020 Sep 30;53(3):372-375.

PMID: 32647076 DOI: 10.5115/acb.20.082

Anomalies of the peritoneum and the colon are quite common. Some of these anomalies can disturb the normal digestive and absorptive functions of the intestine and the others might result in formation of volvulus or impede the blood supply of the intestine. We report a rare, combined variation of peritoneum and ascending colon. In a 70-year-old male cadaver, the greater omentum was very small and extended only for about an inch below the transverse colon. From its lower end, a fibrous band extended to the right wall of the upper part of ascending colon. There was a deep constriction on the right wall of the ascending colon at the site of attachment of the fibrous band. The ascending colon was grossly dilated. Further, the ascending colon was mobile and presented a small ascending mesocolon along its left edge. We discuss the possible embryological basis and clinical and surgical relevance of the case.

Matched MeSH terms: Intestinal Volvulus

PRIMARY VOLVULUS OF THE SMALL INTESTINE

BALASEGARAM M

Med J Malaysia, 1963 Dec;18:122-4.

PMID: 14117280

Matched MeSH terms: Intestinal Volvulus*

Primary extranodal diffuse large B-cell lymphoma of the uterine cervix

Akkour K, Alhulwah M, Alhalal H, Alqahtani N, Arafah M

Malays J Pathol, 2021 Aug;43(2):327-331.

PMID: 34448797

BACKGROUND: Small bowel volvulus is defined as the torsion of the small intestine, potentially leading to bowel obstruction, gangrene and perforation. It is a rare condition, especially in adults.

CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.

CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.

Matched MeSH terms: Intestinal Volvulus*

Fulltext Wandering spleen as a cause of acute abdomen: a surgical conundrum from acute appendicitis to splenic torsion and ischemic small bowel volvulus

Fatimah Najid, Sanjeev Sandrasecra, Mohd Zuki Asyraf, Chang Haur Lee, Nornazirah Azizan, Andee Dzulkarnaen Zakaria, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):336-338.

MyJurnal

Wandering spleen is renowned as a surgical enigma due to its diverse presentations. Due to lack of its attaching ligaments which would usually place it at the left hypochondrium region, the spleen ‘wanders’ and may be located anywhere within the abdominal cavity. This condition has been associated with many complications such as splenic torsion, pancreatitis and portal hypertension. We report a case of a wandering spleen presenting as acute appen- dicitis in an 18-year-old young active sportsman. The patient developed post-operative ileus and later intestinal obstruction which necessitated exploratory laparatomy onto which the final diagnosis of splenic and small bowel infarct due to splenic torsion with small bowel volvulus was made. Splenectomy, small bowel resection and primary anastomosis were performed and the patient made a full recovery.

Matched MeSH terms: Intestinal Volvulus

Fulltext Jejunal interposition for short bowel syndrome in a septuagenarian

Gee T, Lim SY, Sudhakaran N, Hassan MF

J Surg Case Rep, 2019 Apr;2019(4):rjz095.

PMID: 30997009 DOI: 10.1093/jscr/rjz095

Short bowel syndrome in adults occurs as a result of massive small intestinal resection commonly due to severe Crohn's disease, volvulus or tumors. Diarrhea and weight loss are hallmarks of malabsorption which are aggravated if the colon is removed along with the small intestinal resection. Enteral nutrition autonomy is difficult to achieve in such cases of malabsorption where parenteral nutrition are required more often than not. We report a case of short bowel syndrome with severe malabsorption following extensive small bowel removal. The patient eventually underwent intestinal rehabilitation surgery and achieved independence from parenteral nutrition.

Matched MeSH terms: Intestinal Volvulus

Homologs of the Brugia malayi diagnostic antigen BmR1 are present in other filarial parasites but induce different humoral immune responses

Noordin R, Aziz RA, Ravindran B

Filaria journal, 2004 Dec 31;3(1):10.

PMID: 15627400

BACKGROUND: The recombinant antigen BmR1 has been extensively employed in both ELISA and immunochromatographic rapid dipstick (Brugia Rapid) formats for the specific and sensitive detection of IgG4 antibodies against the lymphatic filarial parasites Brugia malayi and Brugia timori. In sera of individuals infected with Wuchereria bancrofti the IgG4 reactivity to BmR1 is variable, and cross-reactivity of sera from individuals infected with Onchocerca volvulus or Loa loa was observed only in single cases. In order to characterize the homologs of the BmR1 antigen in W. bancrofti (Wb-BmR1), O. volvulus (Ov-BmR1) and L. loa (Ll-BmR1) the cDNA sequences were identified, the protein expressed and the antibody reactivity of patients' sera was studied. METHODS: PCR methodology was used to identify the cDNA sequences from cDNA libraries and/or genomic DNA of W. bancrofti, O. volvulus and L. loa. The clones obtained were sequenced and compared to the cDNA sequence of BmR1. Ov-BmR1 and Ll-BmR1 were expressed in E. coli and tested using an IgG4-ELISA with 262 serum samples from individuals with or without B. malayi, W. bancrofti, O. volvulus and L. loa infections or various other parasitic infections. BmR1, Ov-BmR1 and Ll-BmR1 were also tested for reactivity with the other three IgG subclasses in patients' sera. RESULTS: Wb-BmR1 was found to be identical to BmR1. Ov-BmR1 and Ll-BmR1 were found to be identical to each other and share 99.7% homology with BmR1. The pattern of IgG4 recognition of all serum samples to BmR1, Ov-BmR1 and Ll-BmR1 were identical. This included weak IgG4 reactivities demonstrated by L. loa- and O. volvulus-infected patients tested with Ov-BmR1 and Ll-BmR1 (or BmR1). With respect to reactivity to other IgG subclasses, sera from O. volvulus- and L. loa-infected patients showed positive reactions (when tested with BmR1, Ov-BmR1 or Ll-BmR1 antigens) only with IgG1. No reactivity was observed with IgG2 or with IgG3. Similarly, ELISAs to detect reactivity to other anti-filarial IgG subclasses antibodies showed that sera from individuals infected with B. malayi or W. bancrofti (active infections as well as patients with chronic disease) were positive with BmR1 only for IgG1 and were negative when tested with IgG2 and with IgG3 subclasses. CONCLUSIONS: This study demonstrates that homologs of the BmR1 antigen are present in W. bancrofti, O. volvulus and L. loa and that these antigens are highly conserved. Recognition of this antigen by patients' sera is similar with regard to IgG1, IgG2 and IgG3, but different for IgG4 antibodies. We conclude that the BmR1 antigen is suitable for detection of IgG4 antibodies in brugian filariasis. However, its homologs are not suitable for IgG4-based diagnosis of other filarial infections.

Matched MeSH terms: Intestinal Volvulus

Idiopathic ileal volvulus with multiple concomitant infections in a starving man

Tan LJ, Othman MS, Hiu J, Wong KT, Lai SK

Malays J Pathol, 2021 Apr;43(1):81-85.

PMID: 33903310

BACKGROUND: Small bowel volvulus is defined as the torsion of the small intestine, potentially leading to bowel obstruction, gangrene and perforation. It is a rare condition, especially in adults.

CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.

CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.

Matched MeSH terms: Intestinal Volvulus

Fulltext Diagnostic dilemma of a case of sigmoid volvulus complicating pregnancy

Nur Azurah, A.G., Ani Amelia, Z., Sagap, I.

Journal of Surgical Academia, 2011;1(1):46-48.

MyJurnal

We report the case of a 34-year-old Malay, admitted for constipation and abdominal pain at 35 weeks of gestation. Initially, she was diagnosed to have paralytic ileus and was managed conservatively. As her condition did not improve, emergency laparotomy was performed for suspected intestinal obstruction. She delivered a baby boy weighing 2.84kg with good Apgar score through a caesarean section. Intra-operatively, she was noted to have sigmoid volvulus and sigmoidopexy was performed. Post-partum, colonoscopy and bowel decompression was performed. She recovered well and was discharged on day 5. This case illustrates the need to diagnose or suspect volvulus in pregnant woman presenting with severe constipation as early surgical intervention can reduce morbidity to both mother and fetus.

Matched MeSH terms: Intestinal Volvulus

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