Volvulus small bowel

Types of Enema Therapies 43 Appendicitis 46 Appendicitis Imaging 47 Small Bowel Obstruction 56 Midgut Volvulus 58 Meckel s Diverticulum 59 Enteritis 60... 

Partial duodenal obstruction may be produced by duodenal stenosis, duodenal web, Ladd s bands, midgut volvulus, annular pancreas, preduodenal portal vein, and duplication cyst. Plain radiographs show gaseous distension of the stomach and duodenum with a normal or diminished quantity of air in the small bowel. Content studies may be necessary to differentiate between midgut volvulus and partial duodenal obstruction caused by a web or stenosis (Auringer and Sumner 1994). Sonography is helpful to rule out extraluminal causes such as a duplication cyst. 

Besides perforated appendicitis and intussusception, the most common causes of small howel obstruction are incarcerated hernias and adhesions. Other causes of small bowel obstruction comprise a miscellaneous group of rare conditions, such as midgut volvulus, Meckel s diverticulum, advanced stages of Crohn s disease, and bezoars. Adhesions usually result from prior surgery and are often multiple. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. 

Kassner EG, Kottmeier PK (1975) Absence and retention of small bowel gas in infants with midgut volvulus mechanisms and significance. Pediatr Radiol 4 28-30 Katz M, Phelan E, Carlin JB et al (1993) Gas enema for the reduction of intussusception relationship between clinical signs and symptoms and outcome. AJR Am J Roentgenol 160 363-366... 

Complications of meconium ileus are volvulus, perforation, small bowel atresia and meconium peritonitis with abdominal calcifications. 

Fig. 2. Rate of disappearance of i C-labeled conjugated trihydroxy bile salts from the enterohepatic circulation 24 hr after intravenous injection into student volunteers, patients with jejunocolic fistula, and patients with other distal small bowel disorders. O, Resection, volvulus A, resection, regional enteritis A, no resection, radiation no resection, active regional enteritis (see Table I). In part from Heaton et al. (3).

Early diagnosis of small bowel volvulus is crucial for better outcome of management as it can prevent complications. The vascular occlusion can lead to ischaemia and gangrene of the bowel. The closed-loop obstruction may lead to tense disten-... 

In volvulus, due to other causes, the location and axis of the mass with whirlpool appearance can vary. In a mesenteric cyst with volvulus of most of the small bowel, the mass is seen below the pancreas, as seen in volvulus of malrotation (Vijayaraghavan et al. 2004). Alternatively, when the volvulus involves only a segment of small bowel, the mass is located close to the umbihcuSjjust above or to the right of it. The best... 

Fig. 5.9a,b. Closed-loop obstruction in segmental small bowel volvulus, a The proximal dilated loops of bowel show intraluminal fluid with microbubbles of air seen as echogenic dots, b Section through the loops of closed loop show the lumen filled with... 

Kenney IJ (1990) Ultrasound in intussusception a false cystic lead point. Pediatr Radiol 20 348 Kim JH (2004) US features of transient small bowel intussusception in pediatric patients. Korean J Radiol 5 178-184 Kohli A, Vig A, Azad T (1997) Intrathoracic gastric volvulus acute and chronic presentation. J Indian Med Assoc 95 522-523... 

Oh A, Gulati G, Sherman ML, Golub R, Kutin N (2000) Bilateral eventration of the diaphragm with perforated gastric volvulus in an adolescent. J Pediatr Surg 35 1824-1826 Parkes G (1997) Primary small bowel volvulus in rural Nepal. Trop Doct 27 156-158... 

Rodriguez EJ, Gama MA, Ornstein SM, Anderson WD (2003) Ascariasis causing small bowel volvulus. Radiographics 23 1291-1293... 

Perforation of Peptic Ulcer 217 Acute Gastric Volvulus 218 Proximal Small Bowel Volvulus Emphysematous Gastritis 222 Injuries to the Stomach and Duodenum 224 Rupture of the Stomach 224 Intramural Haematoma of the Duodenum 224 Retroperitoneal Rupture of the Duodenum 226 Diaphragmatic Rupture 226 References 228... 

Fig. 12.9a,b. Small bowel malrotation. Plain radiograph demonstrating dilated stomach and first part of the duodenum in an infant with mid-gut volvulus b barium meal confirms the enormous distension of the duodenum. Note the collapsed jejunal loops... 

Enteric comphcations manifest either as leakage of the duodenojejunostomy or duodenal stump with ensuing abscess and peritonitis or sometimes as volvulus from twisting of the small bowel around the longitudinal axis of the graft (Fig. 7.27). 

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