Volvulus

Abstract: Alimentary tract duplications are unusual anomalies that may require surgical intervention in the neonate, infant, and occasionally in the older child. The clinical presentation of patients with alimentary tract duplications includes bleeding, abdominal pain, intussusception, and respiratory distress, or it may be an incidental finding on either abdominal examination or chest x-ray. A review of 96 patients with 101 duplications seen over the last 37 years is reported herein. Twenty-one duplications were confined to the thorax; three were thoracoabdominal, and 77 were abdominal. Seventy-four patients presented as infants less than 2 years of age, and 22 patients were older. Ectopic gastric mucosa was found in 21 duplications, and pancreatic tissue was found in five. Seventy-five duplications were cystic and 26 were tubular. Ultrasonography, computed tomography (CT), and myelography are helpful diagnostic tools. Ninety-four of the 96 patients underwent surgical management for their duplications. One duplication was found at necropsy, and one patient was asymptomatic and did not undergo operation. A single death occurred in a 2-day-old infant who had intrauterine volvulus and meconium peritonitis. Management was based on the age and condition of the patient, the location of the lesion, whether it was cystic or tubular and communicating with the true intestinal lumen, and whether it involved one or more anatomic locations. Generally, total excision was preferred, but staged approaches were sometimes necessary.

Abstract: The computed tomographic appearance of volvulus in intestinal malrotation in an adult is presented. The small-bowel loops encircling the superior mesenteric artery create a whirl-like pattern that may be distinctive for this diagnosis.

Abstract: In 19 patients with closed-loop intestinal obstruction, including 16 patients with strangulating obstruction, the findings at examination with computed tomography (CT) were retrospectively correlated with the surgical and pathologic findings and evaluated by two radiologists. Signs of closed-loop obstruction, present in 15 patients, were associated with the configuration of the incarcerated loop of small bowel, abnormalities detected at the site of obstruction, or both. These abnormalities were the following: a U-shaped, distended, fluid-filled bowel loop; the whirl sign; the beak sign; a triangular loop; two adjacent collapsed loops of bowel at the site of obstruction; or all of these. CT signs of strangulation, seen in 10 of the 16 patients with ischemic or infarcted bowel, were associated with the appearance of the bowel wall (thickening, high attenuation, and the target sign), abnormalities in the attached mesentery, or both. In mechanical obstruction of the small bowel, detection of ischemic changes in the bowel wall or mesentery with CT indicates strangulation. Absence of CT findings of ischemia or infarction does not rule out strangulation.

Abstract: Essential Considerations. Surgical Anatomy. Physiology. Diagnosis. Preoperative and Postoperative Management. Local Anesthesia in Anorectal Surgery. Pharmacology of Anorectal Preparations. Electrosurgery and Laser Surgery: Basic Applications. Anorectal Disorders. Hemorrhoids. Fissure-in-Ano. Anorectal Abscesses and Fistula-in-Ano. Pilonidal Disease. Perianal Dermatologic Disease. Condyloma Acuminatum. Sexually Transmitted Diseases. Anal Incontinence. Rectovaginal Fistula. Retrorectal Tumors. Perianal and Anal Canal Neoplasms. Per Anal and Transanal Techniques. Ambulatory Procedures. Colorectal Disorders. Rectal Procidentia. Benign Neoplasms of the Colon and Rectum. Malignant Neoplasms of the Colon. Malignant Neoplasms of the Rectum. Large Bowel Carcinoma: Screening, Surveillance, and Follow-up. Ulcerative Colitis. Crohn's Disease. Diverticular Disease of the Colon. Volvulus of the Colon. Mesenteric Vascular Diseases. Radiation Injuries to the Small and Large Intestine. Intestinal Stomas. Constipation. Problem-Oriented Approach to Colorectal Disease. Traumatic Injuries. Complications of Colonic Disease and Their Management. Complications of Anorectal and Colorectal Operations. Unexpected Intraoperative Findings. Minimally Invasive Surgery. Laparoscopic Colon and Rectal Surgery. Etcetera. Miscellaneous Entities.