Abstract:Midgut malrotation is an anomaly of intestinal rotation which occurs during fetal development and usually presents in the neonatal period. It is rare for malrotation to present in adulthood. The main purpose of this paper is to show how the clinical picture may be expected to vary and to emphasize the importance of "shock" in massivevolvulus. We present a case of midgut volvulus in an adult male patient (60 year old) who presented with cramping generalized right abdominal pain and vomiting of two days duration. An abdominal ultrasound showed peritoneal effusion and greek distension. An emergency laparotomy showed typical Ladd's bands and small bowel distension. All the intestine from the duodenum to the left colic flexure was found to be suspended on a single dorsal mesentery. This mesentery arose from a narrow base high up in the abdomen and reached down to the pelvic brim. There were numerous areas of fine shiny fibrosis on the small bowel corresponding to sites of previous constriction when a midgut volvulus occurred. A detorsion of the twisted mesentery, lysis of the bands, appendectomy were performed. Complete resolution of symptoms is noted. Acute volvulus of the small intestine is one of the most serious abdominal emergencies. Diagnosis may be difficult and delay in operative intervention can be disastrous.
The management of penetrating wounds of the abdomen is still, at present, a subject of controversy. The aim of this study was to analyse the results of the management of penetrating abdominal wounds. This retrospective study was carried out over a period of 5 years, from January 2017 to January 2021. It covered 90 cases of penetrating abdominal wounds collected at the level of the Surgical Emergency Department of the Mohammed VI University Hospital of Marrakech. It involved 88 men and 2 women, with an average age of 27 years. Two groups of patients were identified. A first group of 61 patients (group I) where the diagnosis of penetration was based on the following findings: epiplocele, evisceration, flow of abdominal fluid, and in which laparotomy was systematically performed. Group II included 29 patients, with no signs of severity, who received simple wound trimming under local anaesthesia with plane-by-plane closure and simple monitoring. Age, gender, causative agent and circumstances of injury were comparable in both groups. The overall mortality was 2.2% (2 cases) and concerned only group I patients. The overall morbidity was 13.3% and consisted of: - 6 cases of peritonitis of which 5 cases were in group II, giving a secondary intervention rate of 17.2%; the other cases of morbidity concerned only group I patients with 3 cases of parietal suppuration, 2 cases of delayed transit resumption and 2 cases of evisceration. The rate of unnecessary or blank laparotomies was 25% in Group I. Laparotomy from the outset in the case of any penetrating wound of the abdomen has the advantage of making a precise assessment of the injury, hence its medico-legal interest, especially in the case of an assault. However, "selective abstentionism" has the advantage of avoiding unnecessary laparotomies. In short, there is no dogma in this matter.
A gastric bezoar is a foreign materiel occur in the stomach & can be extended through duodenum, jejunum and colon. Trichobezoar, is an underdiagnosed entity, has to be considered in children and adolescents (especially females suffering from trichotillomania and trichophagia). The disease is usually underdiagnosed so showed by threatening complications: occlusion, bleeding of perforation. The present report concerns a 19-year-old girl presenting with abdominal pain. On the abdominal exam an acute peritonitis which rapidly evolved to septic shock and an emegercy laparomy was performed, by supraumbilical laparaotomy and anterior gastrotomy objictived peritonitis jejunal perforation caused by large gastrojejunal trichobezoar. Acute peritonitis following hollow viscus perforation caused by tichobezoars is an therapeutic emergency in order to avoid visceral spillage, peritonitis & mortality.
Intestinal cystic pneumatosis (ICP) is a rare disease, defined by the presence of gaseous cysts in the digestive wall with intestinal predilection. The first case was described in autopsy specimen in 1730 by Duo Vernoi. rare condition characterized by multiple gas-filled cysts in the intestinal wall and can be caused by many conditions. As patients with PCI are mostly asymptomatic, they are not likely to seek medical care. It affected any portion of gastrointestinal tract with the cysts being either confined to the mucosa, submucosa, or subserosa or involving all three layers. It is primary in 15% of cases and complicates an underlying pathology in 85% of cases. We report the case of a 47-year-old chronic smoker who had a history of epigastralgia, admitted to the emergency room for an acute abdominal pain with septic shock. A laparotomy was performed showing necrosis ileum with ICP associated to ulcerative pyloric stenosis & ulcer perforation peritonitis. Therapeutic management consisted of specific treatment of the pathology associated with grelic resection of the necrosis ileum affected by ICP. The patient died during his stay in intensive care on 3th day due to multi-visceral failure despite all intense resuscitation efforts.
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