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ContextDespite the advantages of ultrasound (US), upper gastrointestinal contrast series (UGI) remains the first-line diagnostic modality in the diagnosis of midgut malrotation and volvulus in children.ObjectiveEvaluate the diagnostic accuracy of US in the diagnosis of malrotation with or without volvulus in children and adolescents aged 0–21 years, compared with the reference standard (diagnosis by surgery, UGI, CT, MRI, and clinical follow-up individually or as a composite).Data sourcesWe searched the electronic databases Ovid-MEDLINE, Embase, Scopus, CINAHL, and the Cochrane library in October 2019 and updated on 18 August 2020.Study selectionStudies evaluating the diagnostic performance of US for diagnosis of midgut malrotation with or without volvulus in children (0–21 years).Data extraction and synthesisThe data were extracted independently by two authors and a bivariate model was used for synthesis.ResultsMeta-analysis of 17 cohort or cross-sectional studies and 2257 participants estimated a summary sensitivity of 94% (95% CI 89% to 97%) and summary specificity of 100% (95% CI 97% to 100%) (moderate certainty evidence) for the use of US for the diagnosis of malrotation with or without midgut volvulus compared with the reference standard. Subgroup analysis and meta-regression revealed better diagnostic accuracy in malrotation not complicated by volvulus, in the neonatal population and enteric fluid administration before US.ConclusionsModerate certainty evidence suggests excellent diagnostic accuracy and coupled with the advantages, a strong case exists for the use of abdominal US as the first-line diagnostic test for suspected midgut malrotation with or without volvulus in children and adolescents.

[...]SSK, the knotting of WS and sigmoid colon, is an extremely rare condition [5]. [...]according to a search of the last 79 years' (from 1945 to 2024) literature in Web of Science [5] database, there are only two reports on WS and SV comorbidity except for the authors' paper. [...]magnetic resonance imaging (MRI) may be an alternative to CT by presenting similar findings (Fig. 1c) with similar correct diagnosis rates, which procedure is generally preferred in pregnant women [2].

Introduction Colon volvulus is the twisting of a segment of colon on its mesenteric axis, which can lead to the obstruction of the lumen and the blood supply. Colon volvulus is common in “volvulus belt” countries and can involve the sigmoid (60–70%) and cecum (25–40%). Case presentation We report a case of a 47-year-old male, Alawites, who presented with bowel obstruction and dilated abdomen without any specific abdominal pain. Abdominal laparotomy showed both sigmoid and cecum volvulus with no signs of perforation or ischemia. Discussion and conclusion One of the possible risk factors of sigmoid colon volvulus is the length of the rectum and sigmoid, while mobile cecum is considered as a possible reason for cecum volvulus. The management remains controversial and is specific for every case, depending mainly on the vitality of the colonic walls and the general condition of the patient.

Abdominal X-ray showing dilated loops of bowel and evidence of obstruction due to five metallic radiodensities, later identified as magnets. [...]magnets are a particular hazard1; with multiple magnet ingestion being particularly dangerous as the magnets attract to each other, leading to complications such as perforation, fistula and volvulus.2 3 Treatment should be immediate, either endoscopic or surgical if multiple magnets are ingested,2 4 as patients presenting≥12 hours following ingestion develop more complications.5 Even without a history of ingestion, suspected bowel obstruction should be investigated early with abdominal imaging. Surgical management of pediatric multiple magnet Ingestions in the past two decades of minimal access surgery.

This report describes a term neonate with multiple gastrointestinal issues: non-hypertrophic pyloric stenosis (NHPS)-induced gastric volvulus (GV) and ileal volvulus with atresia due to an omphalomesenteric band. The patient presented with early non-bilious vomiting and abdominal distension. Radiological studies indicated GV, gastric outlet obstruction and ileal atresia. An exploratory laparotomy confirmed terminal ileal atresia with volvulus from the fibrous band and NHPS, but no GV was found during surgery. Treatment involved resecting the terminal ileum, ileocaecal valve and caecum, followed by an ileo-ascending colonic anastomosis and pyloroplasty. Recovery was satisfactory. This case highlights the importance of considering a broad differential diagnosis in neonatal intestinal obstruction and conducting a careful evaluation of radiological findings.

Midgut malrotation with volvulus is a surgical emergency with potentially devastating outcomes which include short gut syndrome necessitating long-term parenteral nutrition, overwhelming sepsis, and death. The clinical presentation is most frequently with bilious vomiting in the first days–weeks of life, which is non-specific and common. Timely imaging investigation is therefore crucial to prevent delays to diagnosis and treatment and avoid unnecessary surgical exploration in infants with non-surgical bilious vomiting. Fluoroscopic upper gastrointestinal contrast series (UGI) has been the first-line imaging modality to investigate midgut malrotation at pediatric surgical centers worldwide. However, there is a growing body of evidence to indicate that ultrasound (US) has greater diagnostic accuracy than UGI in this context. Furthermore, US offers the benefits of accessibility, portability, lack of ionizing radiation, and the ability to identify alternative diagnoses, and is beginning to attract significant attention and consideration in the literature. Over the last 3 years, we have transitioned to an “US-first” pathway for the investigation of midgut malrotation in infants with bilious vomiting. This pictorial essay illustrates our comprehensive approach, describes unique troubleshooting techniques, and highlights the variably published pitfalls we have encountered with the aim of encouraging wider adoption.

Purpose Colonic volvulus (CV) is a twist of part of the colon over its mesentery. Although CV is rare in children, its incidence is unknown. Hirschsprung’s disease (HD) represents a significant risk factor of CV in children, especially when diagnosed late. Aim To review the clinical, radiological and management data of children with CV associated with HD. Methods Medical records were reviewed from January 2000 to December 2022 looking for children had CV associated with HD. Results 21 cases (17 males and 4 females) were admitted with CV. Their ages ranged from 8 days to 14 years. Sigmoid volvulus was recorded in 17 (81%) cases, while 4 (19%) cases had cecal volvulus. CV was associated with HD in 9 (42.9%) cases. Their median age was 7 years. Eight cases had sigmoid volvulus associated with short segment HD, while one case had cecal volvulus with long segment HD. CV was the first presentation, before the diagnosis of HD, in 8 cases. The diagnosis of HD was overlooked in 3 cases; 2 cases had an anastomotic leakage after sigmoidectomy, while the third case had recurrence of volvulus after successful nonoperative management. Conclusion The diagnosis of CV in children mandates a high index of suspicion. Moreover, HD should be suspected and excluded in every case of CV in children.

Introduction and importance Large bowel obstruction caused by volvulus poses a life-threatening risk without immediate intervention. Sigmoid colon volvulus is predominant (43–75%), followed by cecal volvulus 10–52%). Synchronous double colonic volvulus is extremely rare, with limited documented cases in academic literature. Case presentation We report a case of synchronous volvulus involving the sigmoid colon and cecum in a 45-year-old male of the Toro tribe from Fort Portal city in western Uganda who presented with acute abdominal pain, distension, and complete constipation for 2 days, accompanied by five episodes of non-bloody feculent vomiting and anorexia. Clinical discussion Upon admission, the patient presented with stable vital signs and a mildly tender, tympanic, distended abdomen with absent bowel sounds. Plain radiographs revealed the characteristic “coffee bean” sign, indicative of sigmoid volvulus. Following optimization, laparotomy confirmed synchronous volvulus involving both the sigmoid and cecum. Subsequently, a total colectomy with end ileostomy was performed, after which the patient experienced an uneventful recovery. Conclusion Synchronous double colonic volvulus, a rare condition, is frequently overlooked clinically. Timely recognition and intervention are crucial to address diagnostic challenges and prevent potentially fatal outcomes. Highlights Synchronous volvulus of the large bowel is a rare and often clinically overlooked condition. Radiological identification is challenging due to mutual distortion of volvulus features. Early detection and timely intervention are paramount in mitigating complications and enhancing patient outcomes.

To analytically depict the associated malformations of polysplenia syndrome (PS) in adults via computed tomography (CT). The incidence of malformations associated with PS in twelve adult patients was retrospectively analyzed via CT imaging. The number of splenic nodules ranged from three to twelve; the splenic nodules were located in the left upper quadrant in nine patients and in the right upper quadrant in three patients. A short pancreas was present in all twelve patients. Midgut malrotation was present in eight patients. Situs inversus totalis was present in two patients. Nine patients presented the absence of hepatic segmental inferior vena cava (IVC), with the hepatic vein directly converging into the right atrium and the continuation of the azygos vein. The preduodenal portal vein was present in six patients. Left lung heterotaxy was found in nine patients. The inferior vena cava was bilateral in one patient. Aberrant right subclavian arteries, bilateral common carotid arteries sharing trunks, abnormal renal vein branching and routing, and abdominal portal vein branching were also found in individual patients. PS is a complex malformation syndrome involving multiple systems. The most common malformation is short pancreas, and other malformations, such as left lung heterogeneity, hepatic segmental IVC agenesis with continuation of the azygos vein, midgut malrotation, preduodenal portal vein, and left atrial heterotaxy, have relatively high prevalence rates.

IntroductionAcute appendicitis in the presence of intestinal malrotation is an uncommon and distinctive clinical condition. Herein, we present a rare case of subumbilical appendicitis resulting from previously undiagnosed intestinal malrotation.Case presentationA 16-year-old Saudi Arab man with no known chronic illness presented with acute suprapubic abdominal pain accompanied by nausea and vomiting. The pain was gradual in onset, dull, nonradiating, and initially localized to the epigastric area before extending to the suprapubic region. The patient denied any history of bowel habit changes, urological symptoms, or prior abdominal surgeries.On physical examination, tenderness was noted over the epigastric and suprapubic regions. Contrast-enhanced abdominal computed tomography revealed intestinal malrotation with subumbilical appendicitis. The patient subsequently underwent an appendectomy. Histopathological analysis confirmed appendicitis with no features of malignancy. The postoperative course was uneventful, and the patient was followed up without complications.ConclusionAlthough appendicitis associated with intestinal malrotation is rare, it should be considered in patients presenting with acute abdominal pain and known or suspected malrotation. Prompt recognition and appropriate imaging are essential to avoid misdiagnosis and ensure timely surgical management.