BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagn...BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.METHODS A systematic review of human studies(PubMed,PubMedCentral,Google Scholar)up to October 2024 was conducted per PRISMA guidelines.Data on demographics,clinical features,diagnostics,treatment,and outcomes were analyzed.RESULTS Antepartum and postpartum volvulus occurred in 75.5%and 24.5%of cases,respectively,most commonly in the third trimester(70.3%).Nausea was less frequent and obstipation was more common in sigmoid volvulus(P=0.0004).Endoscopic detorsion was successful in 23.9%of sigmoid cases,with a mean gestational age of 33.5±3.5 weeks.Maternal mortality was 12.5%for cecal and 5.5%for sigmoid volvulus(P=0.103).While maternal mortality was unaffected by the timing of delivery relative to surgery,fetal mortality was significantly higher when the interval was<24 hours(52.9%vs 10.4%,P<0.001).Both maternal and fetal mortality declined over time.CONCLUSION Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus.Endoscopy was more often used in sigmoid cases.Gestational age and maternal age did not affect fetal outcomes.Earlier imaging and appropriate surgery were linked to lower mortality.Delay>24 hours between intervention and delivery increased fetal,but not maternal mortality.Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.展开更多
Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions accou...Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.展开更多
BACKGROUND Acute gastric volvulus represents a rare form of surgical acute abdomen,which makes it difficult to establish an early diagnosis.As the disease progresses,it can lead to gastric ischemia,necrosis,and other ...BACKGROUND Acute gastric volvulus represents a rare form of surgical acute abdomen,which makes it difficult to establish an early diagnosis.As the disease progresses,it can lead to gastric ischemia,necrosis,and other serious complications.CASE SUMMARY This paper reports a 67-year-old female patient with a history of abdominal distension and retching for 1 day.After admission,a prompt and thorough exami-nation was performed to confirm the diagnosis of acute gastric volvulus.Notably,the patient had free air in the abdominal cavity.The first consideration was gastric volvulus with gastric perforation,but the patient had no complaints,such as abdominal pain or signs of peritoneal irritation in the abdomen,and imaging examination revealed no abdominal pelvic effusion.Following endoscopic reduc-tion,the abdominal organs,such as the stomach and spleen,returned to their normal anatomical positions,and the free intraperitoneal air disappeared,su-ggesting a rare case of acute gastric torsion.The source of free air within the abdominal cavity warrants careful consideration and discussion.Combined with the findings from computed tomography,these findings are hypothesized to be associated with the rupture of colonic air cysts.CONCLUSION Patients with gastric torsion combined with free gas in the abdominal cavity should consider nongastrointestinal perforation factors to avoid misdiagnosis.展开更多
This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings include...This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings included segmental ileus and absent or markedly reduced peristalsis of the affected small intestine, and partial loss of wall layering with increased overall echogenicity of the intestinal wall, but with normal to mildly increased wall thickening. No blood flow was detected in the affected small intestinal wall when assessed with colour Doppler. A moderate amount of peritoneal effusion was also detected with hyperechoic omental and mesenteric fat tissue throughout the peritoneal cavity. Few reports describe ultrasonographic findings of small intestinal ischemia in small animals. In all three cases presented here, ultrasound was helpful in demonstrating typical intestinal wall changes and helped to obtain the correct diagnosis of ischemic disease of the small intestine.展开更多
AIM： To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. METHODS： A retrospective review of the clinical presentation and imaging characteris...AIM： To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. METHODS： A retrospective review of the clinical presentation and imaging characteristics of 33 sigrnoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review. RESULTS： In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigrnoid, Hartmann＇s procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage ＂on table＂ prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay （3 to 8 d after the deflation）. All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigrnoidopexy and one patient underwent a near-total colectomy. Two .patients （sigmoidectomy- sigmoidopexy） had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had only one death （5.9%）, whereas after 15 emergency operations 6 patients died, which means a mortality rate of 40%. CONCLUSION： Although sigmoid volvulus causing intestinal obstruction is frequently successfully encountered by endoscopic decompression, however, the principal therapy of this condition is surgery. Only occasionally in patients with advanced age, lack of bowel symptoms and multiple co-morbidities might surgical repair not be considered.展开更多
The objective of this review is to examine whether a redundant colon gives rise to symptoms like constipation and volvulus. In 1820, Monterossi made drawings of colons with displacements and elongation of the colon fo...The objective of this review is to examine whether a redundant colon gives rise to symptoms like constipation and volvulus. In 1820, Monterossi made drawings of colons with displacements and elongation of the colon found during autopsy. In 1912, Kienb?eck first visualized a redundant colon using bismuth, and Lardennois and Auborg named the anatomic variant dolichocolon in 1914. The criteria were later: A sigmoid loop rising over the line between the iliac crests, a transverse colon below the same line and extra loops at the flexures. The incidence of dolichocolon is 1.9%-28.5%. Dolichocolon seems to be congenital, as fetuses, newborns, and infants exhibit colonic redundancies. Studies have identified a triade of constipation, abdominal pain, and distension. Colon transit time was recently shown to increase significantly with increased number of redundancies, which increases abdominal pain, bloating and infrequent defecation. The diagnosis of dolichocolon is established by barium enema or CT-colonography. Treatment is conservative, or surgical in case of volvulus or refractory constipation.展开更多
Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical an...Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies,while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions,intestinal diverticulum,and/or tumors. Here,we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography(MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum,longer corresponding mesentery with a narrower insertion,and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus,and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.展开更多
AIM:To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting.METHODS:A retrospective review of 28 patients with acute sigmoid volvulus treated in the De...AIM:To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting.METHODS:A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery,Changhai Hospital,Shanghai from January 2001 to July 2012 was performed.Following the diagnosis of acute sigmoid volvulus,an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis.RESULTS:Of the 28 patients with acute sigmoid volvulus,19(67.9%)were male and 9(32.1%)were female.Their mean age was 63.1 ± 22.9 years(range,21-93 years).Six(21.4%)patients had a history of abdominal surgery,and 17(60.7%)patients had a history of constipation.Abdominal radiography or computed tomography was performed in all patients.Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8%(26/28).Emergency surgery was required in the other two patients.Of the 26 successfully treated patients,seven(26.9%)had recurrent volvulus.CONCLUSION:Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus.Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful,or in those with peritonitis.展开更多
Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation c...Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.展开更多
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, dur...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 2.79 kg, 33-wk infant was born via a spontaneous vaginal delivery caused by preterm labor. Prenatal ultrasound showed dilated bowel loops with the appearance of a 'coffee bean sign'. 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.展开更多
Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mese...Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.展开更多
AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus. METHODS: From March 2000 to September 2007, 77 patients with acute sigmoid volvu...AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus. METHODS: From March 2000 to September 2007, 77 patients with acute sigmoid volvulus were treated. A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy. Twenty-five patients received RPA (Group A), and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B). The clinical course and postoperative complications of the two groups were compared. RESULTS: The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Superficial wound infection rate was higher in group A (32% vs 9.1%). Anastomotic leakage was observed only in group A, with a rate of 6.3%. The difference was numerically impressive but was statistically not significant. CONCLUSION: RPA with modified blow-hole colostomy provides satisfactory results. It is easy to perform and may become a method of choice in patients with sigmoid volvulus. Further studies are required to further establish its role in the treatment of sigmoid volvulus.展开更多
BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but seri...BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but serious complications.Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom,which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias.After the operation,he experienced recurring pain in his lower right abdomen around the surgical area,which was relieved after symptomatic treatment.Three months after the surgery,the abdominal pain became severe and was aggravated over time.The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography(CT).Laparoscopic exploration confirmed that a barb of the V-Loc™suture penetrated the peritoneum,which caused the adhesion of the small intestinal wall to the site of peritoneal injury,forming intestinal volvulus.Since there was no closed-loop obstruction or intestinal ischemia,recurrent abdominal pain became the only clinical manifestation in this case.After laparoscopic lysis of adhesions and reduction of intestinal volvulus,the patient recovered and was discharged.CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum.Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.展开更多
We report the case of a 25-year-old male with Neurofibromatosis type I (NF-1), who presented at the time of admission with clinical findings of an acute abdomen caused by a mechanical obstructi...We report the case of a 25-year-old male with Neurofibromatosis type I (NF-1), who presented at the time of admission with clinical findings of an acute abdomen caused by a mechanical obstruction. Computerized tomography showed a volvulus of the terminal ileum with mesenteric swirling as the cause of the patient’s symptoms. Consecutive exploratory laparotomy confirmed the diagnosis and 70 cm of the small intestine was resected due to an affection of the mesentery by multiple neurofibromas. The gastrointestinal tract is affected in approximately 10% of patients with NF-1, however the mesentery is almost always spared. Here we describe the unique case of a patient with a volvulus caused by mesenteric manifestation of von Recklinghausen’s disease, emphasizing the role of surgery in a team of multidisciplinary specialists to treat this multiorganic disease.展开更多
Jejunal diverticulosis is uncommon and often asymptomatic.It can produce significant complications,and some complications are potentially life threatening and require early surgical treatment,such as obstruction,hemor...Jejunal diverticulosis is uncommon and often asymptomatic.It can produce significant complications,and some complications are potentially life threatening and require early surgical treatment,such as obstruction,hemorrhage and perforation.There is no consensus on the management of this disease.Only a few cases of jejunal diverticulosis with midgut volvulus have been reported.We herein report a case of 57-year-old woman with jejunal diverticulosis causing small bowel volvulus who complained of intermittent upper abdominal pin-prick for 5 years that eventually progressed to a complete obstruction.The computed tomography scans revealed a mesenteric vessel "whirlpool" and laparotomy showed midgut volvulus secondary to jejunal diverticula.This case highlights jejunal diverticulosis causing small bowel volvulus as an uncommon mechanism of small bowel obstruction,which should be included in the differential diagnosis of small bowel obstruction.展开更多
The exact aetiology of sigmoid volvulus in Parkinson's disease(PD) remains unclear.A multiplicity of factors may give rise to decreased gastrointestinal function in PD patients.Early recognition and treatment of c...The exact aetiology of sigmoid volvulus in Parkinson's disease(PD) remains unclear.A multiplicity of factors may give rise to decreased gastrointestinal function in PD patients.Early recognition and treatment of constipation in PD patients may alter complications like sigmoid volvulus.Treatment of sigmoid volvulus in PD patients does not differ from other patients and involves endoscopic detorsion.If feasible,secondary sigmoidal resection should be performed.However,if the expected surgical morbidity and mortality is unacceptably high or if the patient refuses surgery,percutaneous endoscopic colostomy(PEC) should be considered.We describe an elderly PD patient who presented with sigmoid volvulus.She was treated conservatively with endoscopic detorsion.Surgery was consistently refused by the patient.After recurrence of the sigmoid volvulus a PEC was placed.展开更多
OBJECTIVE:To study the preventative effects of massage on gastric volvulus(GV) in infants with gastroesophageal reflux(GER)-induced pneumonia.METHODS:One-hundred and eighty GV with GER-induced pneumonia inpatients wer...OBJECTIVE:To study the preventative effects of massage on gastric volvulus(GV) in infants with gastroesophageal reflux(GER)-induced pneumonia.METHODS:One-hundred and eighty GV with GER-induced pneumonia inpatients were divided randomly into four groups:basic treatment 1(n =60),basic treatment 2(n = 30),massage treatment1(n = 60) and massage treatment 2(n = 30).Clinical examinations selected between groups 1 and 2were different.Radiography of the upper gastrointestinal tract using iodine-containing contrast was assessed in group 1 before and after treatment,whereas 24-h pH monitoring of the distal esophagus was assessed in group 2 before and after treatment.Symptom scores and chest radiography were assessed in all groups upon hospital admission and after procedures.Clinical effects were estimated after procedures in all groups.The prevalence of severe pneumonia among the four groups was compared.RESULTS:Massage treatment groups showed a significantly higher percentage of cure and total effect(P<0.05,P<0.01) and a lower prevalence of recurrence(but with no statistic difference,P>0.05)than basic treatment groups.Furthermore,massage treatment groups had remarkably lower scores for symptoms and signs(P<0.05,P<0.01),especially for choking on milk,than basic treatment groups.There was significant attenuation of chest inflammation(P<0.05,P<0.01),GV(P<0.05,P<0.01) and GER(P<0.05,P<0.01) in massage treatment groups compared with those in basic treatment groups.Finally,massage treatment groups demonstrated a lower prevalence of severe pneumonia than basic treatment groups(P<0.05).CONCLUSION:Massage treatment can prevent GV with GER-induced pneumonia in infants by timely correction of stomach rotation and subsequent attenuation of GER.展开更多
Introduction: The present report describes a case of a giant sigmoid volvulus (SV) where acute respiratory distress was associated with toxic megacolon. Clinical features, surgical treatment and postoperative course d...Introduction: The present report describes a case of a giant sigmoid volvulus (SV) where acute respiratory distress was associated with toxic megacolon. Clinical features, surgical treatment and postoperative course deserved our attention and discussion. Presentation of Case: A 67-year-old man with psychiatric disturbances was admitted to our Department with severe respiratory distress due to an enormous abdominal distension caused by a sigmoid volvulus. Endoscopic derotation was unsuccessful and surgery immediately performed. After a wide colonic resection the patient underwent a prolonged treatment in the Intensive Care Unit. Death occurred 34 days after the operation for secondary infection of peritoneal effusion. Discussion: Main clinical features of SV pertain to abdominal compartment while in the present case acute respiratory distress was the prominent symptom;in the same time the severity of the case was due to the association of high abdominal pressure together with a toxic megacolon. Postoperative treatment consisted in ventilatory support, with a progressive shift from asssisted to spontaneous ventilation;repeated sessions of haemodialysis were necessary to manage renal failure up to recovery of the urine output. Bacterial trans location due to toxic megacolon was responsible of late infection of ascitic fluid. In spite of multiple antibiotic association according to bacterial cultures, intra-abdominal abscesses eventually developed causing fatal outcome 34 days after the first intervention. Conclusion: Severe clinical presentation required a prolonged and demanding postoperative course which was focused on the recovery of respiratory, cardiac and renal function even if fatal outcome was due to septic complications. Suspicion of late infection of ascitic fluid could arise from persistently high values of inflammation indexes and drive to an earlier drainage of the abdominal abscesses.展开更多
The objective of this study was to describe the therapeutic aspects and to evaluate the surgery results of sigmoid Volvulus in the Kati (MALIA) General Surgery Department. Patients and Methods: This was a descriptive ...The objective of this study was to describe the therapeutic aspects and to evaluate the surgery results of sigmoid Volvulus in the Kati (MALIA) General Surgery Department. Patients and Methods: This was a descriptive study conducted in our General Surgery Department. It took place in two phases for six years: A retrospective phase from January 1st, 2010 to December 31st, 2015 and a prospective phase from January 1st, 2016 to December 31st, 2017. This study has been approved by the Ethics Committee. It’s concerned all the patients operated in the department for colon Volvulus. Results: We collected 70 patients’ files. The Sigmoid Volvulus represented 7.8% of emergency surgery activities and 37.2% of intestinal obstruction. The male sex predominated with 98.57% against 1.43% of the female sex. The average age was 42.11 years old with limits of 18 to 70. The average deadline evolution was 2.53 days with limits of 1 to 3. The sigmoidectomy with immediate anastomosis was performed in 66% of patients, colectomy with 2-times anastomosis: according to Hartman 20% and Bouilly Volkman 11%, detorsion with colopexy 3%. The early morbidity rate was 5.71%. The average duration of hospitalization was 10.8 days with limits of 5 to 40 days. Two deaths were recorded. Conclusion: Sigmoid Volvulus is frequent in young adult sex male in Africa. We did not find any significant difference between the surgical technique and the advent of complications. The Colectomy with immediate anastomosis seems to be ideal to us that anytime the conditions are appropriate.展开更多
AIM:To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus(IGV)and to assess the preoperative work-up.METHODS:A retrospective review of a prospectively collected data...AIM:To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus(IGV)and to assess the preoperative work-up.METHODS:A retrospective review of a prospectively collected database of patient medical records identified14 patients who underwent a laparoscopic repair of IGV.The procedure included reduction of the stomach into the abdomen,total sac excision,reinforced hiatoplasty with mesh and construction of a partial fundoplication.All perioperative data,operative details and complications were recorded.All patients had at least 6 mo of follow-up.RESULTS:There were 4 male and 10 female patients.The mean age and the mean body mass index were 66years and 28.7 kg/m2,respectively.All patients presented with epigastric discomfort and early satiety.There was no mortality,and none of the cases were converted to an open procedure.The mean operative time was235 min,and the mean length of hospitalization was 2 d.There were no intraoperative complications.Four minor complications occurred in 3 patients including pleuraleffusion,subcutaneous emphysema,dysphagia and delayed gastric emptying.All minor complications resolved spontaneously without any intervention.During the mean follow-up of 29 mo,one patient had a radiological wrap herniation without volvulus.She remains symptom free with daily medication.CONCLUSION:The laparoscopic management of IGV is a safe but technically demanding procedure.The best outcomes can be achieved in centers with extensive experience in minimally invasive esophageal surgery.展开更多
文摘BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.METHODS A systematic review of human studies(PubMed,PubMedCentral,Google Scholar)up to October 2024 was conducted per PRISMA guidelines.Data on demographics,clinical features,diagnostics,treatment,and outcomes were analyzed.RESULTS Antepartum and postpartum volvulus occurred in 75.5%and 24.5%of cases,respectively,most commonly in the third trimester(70.3%).Nausea was less frequent and obstipation was more common in sigmoid volvulus(P=0.0004).Endoscopic detorsion was successful in 23.9%of sigmoid cases,with a mean gestational age of 33.5±3.5 weeks.Maternal mortality was 12.5%for cecal and 5.5%for sigmoid volvulus(P=0.103).While maternal mortality was unaffected by the timing of delivery relative to surgery,fetal mortality was significantly higher when the interval was<24 hours(52.9%vs 10.4%,P<0.001).Both maternal and fetal mortality declined over time.CONCLUSION Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus.Endoscopy was more often used in sigmoid cases.Gestational age and maternal age did not affect fetal outcomes.Earlier imaging and appropriate surgery were linked to lower mortality.Delay>24 hours between intervention and delivery increased fetal,but not maternal mortality.Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.
文摘Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.
文摘BACKGROUND Acute gastric volvulus represents a rare form of surgical acute abdomen,which makes it difficult to establish an early diagnosis.As the disease progresses,it can lead to gastric ischemia,necrosis,and other serious complications.CASE SUMMARY This paper reports a 67-year-old female patient with a history of abdominal distension and retching for 1 day.After admission,a prompt and thorough exami-nation was performed to confirm the diagnosis of acute gastric volvulus.Notably,the patient had free air in the abdominal cavity.The first consideration was gastric volvulus with gastric perforation,but the patient had no complaints,such as abdominal pain or signs of peritoneal irritation in the abdomen,and imaging examination revealed no abdominal pelvic effusion.Following endoscopic reduc-tion,the abdominal organs,such as the stomach and spleen,returned to their normal anatomical positions,and the free intraperitoneal air disappeared,su-ggesting a rare case of acute gastric torsion.The source of free air within the abdominal cavity warrants careful consideration and discussion.Combined with the findings from computed tomography,these findings are hypothesized to be associated with the rupture of colonic air cysts.CONCLUSION Patients with gastric torsion combined with free gas in the abdominal cavity should consider nongastrointestinal perforation factors to avoid misdiagnosis.
文摘This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings included segmental ileus and absent or markedly reduced peristalsis of the affected small intestine, and partial loss of wall layering with increased overall echogenicity of the intestinal wall, but with normal to mildly increased wall thickening. No blood flow was detected in the affected small intestinal wall when assessed with colour Doppler. A moderate amount of peritoneal effusion was also detected with hyperechoic omental and mesenteric fat tissue throughout the peritoneal cavity. Few reports describe ultrasonographic findings of small intestinal ischemia in small animals. In all three cases presented here, ultrasound was helpful in demonstrating typical intestinal wall changes and helped to obtain the correct diagnosis of ischemic disease of the small intestine.
文摘AIM： To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. METHODS： A retrospective review of the clinical presentation and imaging characteristics of 33 sigrnoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review. RESULTS： In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigrnoid, Hartmann＇s procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage ＂on table＂ prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay （3 to 8 d after the deflation）. All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigrnoidopexy and one patient underwent a near-total colectomy. Two .patients （sigmoidectomy- sigmoidopexy） had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had only one death （5.9%）, whereas after 15 emergency operations 6 patients died, which means a mortality rate of 40%. CONCLUSION： Although sigmoid volvulus causing intestinal obstruction is frequently successfully encountered by endoscopic decompression, however, the principal therapy of this condition is surgery. Only occasionally in patients with advanced age, lack of bowel symptoms and multiple co-morbidities might surgical repair not be considered.
文摘The objective of this review is to examine whether a redundant colon gives rise to symptoms like constipation and volvulus. In 1820, Monterossi made drawings of colons with displacements and elongation of the colon found during autopsy. In 1912, Kienb?eck first visualized a redundant colon using bismuth, and Lardennois and Auborg named the anatomic variant dolichocolon in 1914. The criteria were later: A sigmoid loop rising over the line between the iliac crests, a transverse colon below the same line and extra loops at the flexures. The incidence of dolichocolon is 1.9%-28.5%. Dolichocolon seems to be congenital, as fetuses, newborns, and infants exhibit colonic redundancies. Studies have identified a triade of constipation, abdominal pain, and distension. Colon transit time was recently shown to increase significantly with increased number of redundancies, which increases abdominal pain, bloating and infrequent defecation. The diagnosis of dolichocolon is established by barium enema or CT-colonography. Treatment is conservative, or surgical in case of volvulus or refractory constipation.
基金Supported by National Natural Science Foundation of China,No.81372364 and No.81000189General Financial Grant from the China Postdoctoral Science Foundation,No.2014M552695
文摘Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies,while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions,intestinal diverticulum,and/or tumors. Here,we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography(MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum,longer corresponding mesentery with a narrower insertion,and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus,and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.
基金Supported by Changhai Hospital 1255 project Fund,No.CH125542500
文摘AIM:To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting.METHODS:A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery,Changhai Hospital,Shanghai from January 2001 to July 2012 was performed.Following the diagnosis of acute sigmoid volvulus,an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis.RESULTS:Of the 28 patients with acute sigmoid volvulus,19(67.9%)were male and 9(32.1%)were female.Their mean age was 63.1 ± 22.9 years(range,21-93 years).Six(21.4%)patients had a history of abdominal surgery,and 17(60.7%)patients had a history of constipation.Abdominal radiography or computed tomography was performed in all patients.Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8%(26/28).Emergency surgery was required in the other two patients.Of the 26 successfully treated patients,seven(26.9%)had recurrent volvulus.CONCLUSION:Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus.Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful,or in those with peritonitis.
文摘Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.
文摘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 2.79 kg, 33-wk infant was born via a spontaneous vaginal delivery caused by preterm labor. Prenatal ultrasound showed dilated bowel loops with the appearance of a 'coffee bean sign'. 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.
基金Supported by The Department of Surgery Fujita Health University School of Medicine and University Hospital
文摘Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.
文摘AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus. METHODS: From March 2000 to September 2007, 77 patients with acute sigmoid volvulus were treated. A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy. Twenty-five patients received RPA (Group A), and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B). The clinical course and postoperative complications of the two groups were compared. RESULTS: The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Superficial wound infection rate was higher in group A (32% vs 9.1%). Anastomotic leakage was observed only in group A, with a rate of 6.3%. The difference was numerically impressive but was statistically not significant. CONCLUSION: RPA with modified blow-hole colostomy provides satisfactory results. It is easy to perform and may become a method of choice in patients with sigmoid volvulus. Further studies are required to further establish its role in the treatment of sigmoid volvulus.
文摘BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but serious complications.Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom,which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias.After the operation,he experienced recurring pain in his lower right abdomen around the surgical area,which was relieved after symptomatic treatment.Three months after the surgery,the abdominal pain became severe and was aggravated over time.The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography(CT).Laparoscopic exploration confirmed that a barb of the V-Loc™suture penetrated the peritoneum,which caused the adhesion of the small intestinal wall to the site of peritoneal injury,forming intestinal volvulus.Since there was no closed-loop obstruction or intestinal ischemia,recurrent abdominal pain became the only clinical manifestation in this case.After laparoscopic lysis of adhesions and reduction of intestinal volvulus,the patient recovered and was discharged.CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum.Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.
文摘We report the case of a 25-year-old male with Neurofibromatosis type I (NF-1), who presented at the time of admission with clinical findings of an acute abdomen caused by a mechanical obstruction. Computerized tomography showed a volvulus of the terminal ileum with mesenteric swirling as the cause of the patient’s symptoms. Consecutive exploratory laparotomy confirmed the diagnosis and 70 cm of the small intestine was resected due to an affection of the mesentery by multiple neurofibromas. The gastrointestinal tract is affected in approximately 10% of patients with NF-1, however the mesentery is almost always spared. Here we describe the unique case of a patient with a volvulus caused by mesenteric manifestation of von Recklinghausen’s disease, emphasizing the role of surgery in a team of multidisciplinary specialists to treat this multiorganic disease.
文摘Jejunal diverticulosis is uncommon and often asymptomatic.It can produce significant complications,and some complications are potentially life threatening and require early surgical treatment,such as obstruction,hemorrhage and perforation.There is no consensus on the management of this disease.Only a few cases of jejunal diverticulosis with midgut volvulus have been reported.We herein report a case of 57-year-old woman with jejunal diverticulosis causing small bowel volvulus who complained of intermittent upper abdominal pin-prick for 5 years that eventually progressed to a complete obstruction.The computed tomography scans revealed a mesenteric vessel "whirlpool" and laparotomy showed midgut volvulus secondary to jejunal diverticula.This case highlights jejunal diverticulosis causing small bowel volvulus as an uncommon mechanism of small bowel obstruction,which should be included in the differential diagnosis of small bowel obstruction.
文摘The exact aetiology of sigmoid volvulus in Parkinson's disease(PD) remains unclear.A multiplicity of factors may give rise to decreased gastrointestinal function in PD patients.Early recognition and treatment of constipation in PD patients may alter complications like sigmoid volvulus.Treatment of sigmoid volvulus in PD patients does not differ from other patients and involves endoscopic detorsion.If feasible,secondary sigmoidal resection should be performed.However,if the expected surgical morbidity and mortality is unacceptably high or if the patient refuses surgery,percutaneous endoscopic colostomy(PEC) should be considered.We describe an elderly PD patient who presented with sigmoid volvulus.She was treated conservatively with endoscopic detorsion.Surgery was consistently refused by the patient.After recurrence of the sigmoid volvulus a PEC was placed.
基金Supported by Clinical Scientific Research Project of Wuhan Health Bureau(No.WZ12C08)
文摘OBJECTIVE:To study the preventative effects of massage on gastric volvulus(GV) in infants with gastroesophageal reflux(GER)-induced pneumonia.METHODS:One-hundred and eighty GV with GER-induced pneumonia inpatients were divided randomly into four groups:basic treatment 1(n =60),basic treatment 2(n = 30),massage treatment1(n = 60) and massage treatment 2(n = 30).Clinical examinations selected between groups 1 and 2were different.Radiography of the upper gastrointestinal tract using iodine-containing contrast was assessed in group 1 before and after treatment,whereas 24-h pH monitoring of the distal esophagus was assessed in group 2 before and after treatment.Symptom scores and chest radiography were assessed in all groups upon hospital admission and after procedures.Clinical effects were estimated after procedures in all groups.The prevalence of severe pneumonia among the four groups was compared.RESULTS:Massage treatment groups showed a significantly higher percentage of cure and total effect(P<0.05,P<0.01) and a lower prevalence of recurrence(but with no statistic difference,P>0.05)than basic treatment groups.Furthermore,massage treatment groups had remarkably lower scores for symptoms and signs(P<0.05,P<0.01),especially for choking on milk,than basic treatment groups.There was significant attenuation of chest inflammation(P<0.05,P<0.01),GV(P<0.05,P<0.01) and GER(P<0.05,P<0.01) in massage treatment groups compared with those in basic treatment groups.Finally,massage treatment groups demonstrated a lower prevalence of severe pneumonia than basic treatment groups(P<0.05).CONCLUSION:Massage treatment can prevent GV with GER-induced pneumonia in infants by timely correction of stomach rotation and subsequent attenuation of GER.
文摘Introduction: The present report describes a case of a giant sigmoid volvulus (SV) where acute respiratory distress was associated with toxic megacolon. Clinical features, surgical treatment and postoperative course deserved our attention and discussion. Presentation of Case: A 67-year-old man with psychiatric disturbances was admitted to our Department with severe respiratory distress due to an enormous abdominal distension caused by a sigmoid volvulus. Endoscopic derotation was unsuccessful and surgery immediately performed. After a wide colonic resection the patient underwent a prolonged treatment in the Intensive Care Unit. Death occurred 34 days after the operation for secondary infection of peritoneal effusion. Discussion: Main clinical features of SV pertain to abdominal compartment while in the present case acute respiratory distress was the prominent symptom;in the same time the severity of the case was due to the association of high abdominal pressure together with a toxic megacolon. Postoperative treatment consisted in ventilatory support, with a progressive shift from asssisted to spontaneous ventilation;repeated sessions of haemodialysis were necessary to manage renal failure up to recovery of the urine output. Bacterial trans location due to toxic megacolon was responsible of late infection of ascitic fluid. In spite of multiple antibiotic association according to bacterial cultures, intra-abdominal abscesses eventually developed causing fatal outcome 34 days after the first intervention. Conclusion: Severe clinical presentation required a prolonged and demanding postoperative course which was focused on the recovery of respiratory, cardiac and renal function even if fatal outcome was due to septic complications. Suspicion of late infection of ascitic fluid could arise from persistently high values of inflammation indexes and drive to an earlier drainage of the abdominal abscesses.
文摘The objective of this study was to describe the therapeutic aspects and to evaluate the surgery results of sigmoid Volvulus in the Kati (MALIA) General Surgery Department. Patients and Methods: This was a descriptive study conducted in our General Surgery Department. It took place in two phases for six years: A retrospective phase from January 1st, 2010 to December 31st, 2015 and a prospective phase from January 1st, 2016 to December 31st, 2017. This study has been approved by the Ethics Committee. It’s concerned all the patients operated in the department for colon Volvulus. Results: We collected 70 patients’ files. The Sigmoid Volvulus represented 7.8% of emergency surgery activities and 37.2% of intestinal obstruction. The male sex predominated with 98.57% against 1.43% of the female sex. The average age was 42.11 years old with limits of 18 to 70. The average deadline evolution was 2.53 days with limits of 1 to 3. The sigmoidectomy with immediate anastomosis was performed in 66% of patients, colectomy with 2-times anastomosis: according to Hartman 20% and Bouilly Volkman 11%, detorsion with colopexy 3%. The early morbidity rate was 5.71%. The average duration of hospitalization was 10.8 days with limits of 5 to 40 days. Two deaths were recorded. Conclusion: Sigmoid Volvulus is frequent in young adult sex male in Africa. We did not find any significant difference between the surgical technique and the advent of complications. The Colectomy with immediate anastomosis seems to be ideal to us that anytime the conditions are appropriate.
文摘AIM:To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus(IGV)and to assess the preoperative work-up.METHODS:A retrospective review of a prospectively collected database of patient medical records identified14 patients who underwent a laparoscopic repair of IGV.The procedure included reduction of the stomach into the abdomen,total sac excision,reinforced hiatoplasty with mesh and construction of a partial fundoplication.All perioperative data,operative details and complications were recorded.All patients had at least 6 mo of follow-up.RESULTS:There were 4 male and 10 female patients.The mean age and the mean body mass index were 66years and 28.7 kg/m2,respectively.All patients presented with epigastric discomfort and early satiety.There was no mortality,and none of the cases were converted to an open procedure.The mean operative time was235 min,and the mean length of hospitalization was 2 d.There were no intraoperative complications.Four minor complications occurred in 3 patients including pleuraleffusion,subcutaneous emphysema,dysphagia and delayed gastric emptying.All minor complications resolved spontaneously without any intervention.During the mean follow-up of 29 mo,one patient had a radiological wrap herniation without volvulus.She remains symptom free with daily medication.CONCLUSION:The laparoscopic management of IGV is a safe but technically demanding procedure.The best outcomes can be achieved in centers with extensive experience in minimally invasive esophageal surgery.
