ACR Appropriateness Criteria® Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass: 2024 Update.

Acute scrotum is a medical emergency that requires prompt accurate diagnosis to appropriately triage potentially surgical conditions. Numerous differential diagnoses with overlapping clinical presentations make this a diagnostic challenge. Ultrasound is the established first-line imaging modality for acute scrotal disease and can be used to diagnose most scrotal disorders promptly and with high accuracy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Correction of Tetratorsional Malalignment of the Lower Extremities Improves Patient-Reported Outcomes.

Background: Axial malalignment of the bilateral femurs and tibias, previously known as "miserable" malalignment, now renamed tetratorsional malalignment (TTM), presents with hip and/or knee pain refractory to nonoperative treatment. Purpose: We sought to investigate whether bilateral rotational osteotomy of the femur and tibia leads to improvement in a deformity-specific patient-reported outcome measure (PROM). Methods: A retrospective review of patients who underwent staged rotational correction of the bilateral femur and tibias was performed. Computed tomography (CT) was used to measure the preoperative rotational profile and plan the surgical correction. Stabilization was predominantly with intramedullary nails. The primary outcome measure was the Limb Deformity-modified Scoliosis Research Society (LDSRS) score. Secondary outcomes included change in mechanical limb alignment and complications of the procedure. Results: Sixteen patients (13 female and 3 male) with average age of 23.1 years (range: 15-36 years) underwent 4-segment rotational correction. The averages for femoral and tibial deformity correction were 23.5° (6.2° SD) and 20.9° (5.2° SD), respectively. The total LDSRS score improved from 3.67 (0.3 SD) to 4.39 (0.3 SD) (P = .001). The LDSRS sub-scores for function, pain, and self-image also significantly improved. In patients not undergoing concurrent coronal deformity correction, the limb mechanical axis was not significantly changed. No additional procedures were performed to obtain bone union. Three patients required peroneal nerve decompression following the index procedure, and all neurologic symptoms resolved. Conclusion: This retrospective review suggests that correction of TTM of the lower extremities may lead to improvements in function, pain, and self-image. There were minimal complications and no iatrogenic deformity among 16 patients reviewed. The new diagnosis, TTM, is descriptive of this debilitating condition without communicating a negative patient image.

Pancreatic torsion in a puppy with an acute abdomen.

OBJECTIVE: To describe the treatment of a unique cause of acute abdomen in a puppy. CASE SUMMARY: An 11-week, 5-day-old female intact Alaskan Malamute was presented to an emergency service for an acute onset of vomiting. On evaluation, the puppy was found to have cranial abdominal pain with an otherwise normal physical examination. An inflammatory leukogram with no other clinically significant findings was found on the initial diagnostics. An abdominal ultrasound showed peritoneal effusion and a lobulated structure in the left cranial abdomen. An emergency exploratory celiotomy was performed, during which evidence of torsion was found in the left limb of the pancreas, which was subsequently excised from the abdomen. The puppy was hospitalized overnight and discharged the next day. Histopathology of the pancreas was consistent with torsion. UNIQUE INFORMATION PROVIDED: Pancreatic torsion is a rare but potential cause of acute abdomen in dogs and can be successfully treated with surgical excision.

Acute adnexa with preserved flow to the ovary: Could isolated tubal torsion be the cause?

STUDY OBJECTIVE: Isolated tubal torsion (ITT) is a surgical emergency that is less well characterized than ovarian torsion and presents with its own diagnostic challenges. We retrospectively examined patients with ITT and compared them to patients with ovarian torsion to better understand the unique features of this pathophysiologic process. METHODS: The medical records of patients who were identified as having ITT or ovarian torsion intraoperatively between January 2019 and November 2022 were reviewed. Patient demographics, clinical documentation, diagnostic imaging reports, operative reports, and pathology results were collected. RESULTS: A total of 82 patients met inclusion criteria of which 62 (75.6%) had ovarian torsion and 20 (24.4%) had ITT. Most patients (63.4%) underwent 2 or more imaging studies prior to the operating room. A diagnosis of torsion occurred more often on preoperative imaging for the ovarian torsion group (67.7% ovarian torsion vs 35.0% ITT, p=0.01). Doppler flow to the ovary was expectedly absent in 65.9% of ovarian torsion patients but interestingly also absent in 25% of ITT patients (p=0.01). Patients with ovarian torsion were more likely to have ovarian cysts (56.5% vs 10.0%, p<0.001), while patients with ITT were significantly more likely to have a paratubal cyst (90.0% vs 38.7%, p<0.001). CONCLUSION: ITT is a surgical emergency that poses a risk to future fertility. Ultrasound studies, including doppler, may not be as definitive in patients with ITT and early cross-sectional imaging should be considered. When there is a high clinical suspicion for ovarian torsion or ITT, there should be a low threshold for diagnostic laparoscopy.

Feasibility of Intraoperative 3-Dimensional Speckle-Tracking Echocardiography in Patients Undergoing Surgical Aortic Valve Replacement: A Prospective Observational Pilot Study.

OBJECTIVES: To assess the feasibility of intraoperative 3-dimensional speckle-tracking-based myocardial deformation analysis for evaluation of twist, torsion, and strain using speckle tracking, and to investigate the immediate changes in these parameters after aortic valve replacement. DESIGN: Prospective observational study SETTING: Single-center study at a tertiary academic cardiac center PARTICIPANTS: Forty-nine patients undergoing minimally invasive surgical aortic valve replacement INTERVENTIONS: Acquisition of full-volume images of the left ventricle after induction of anesthesia and at the end of surgery using transesophageal echocardiography (TEE), and analysis of the datasets using 3D speckle-tracking-based myocardial deformation analysis (Tomtec Arena). MEASUREMENTS AND MAIN RESULTS: Of the 49 complete volume datasets, 30 (61%) had quality sufficient for speckle tracking. No significant differences were observed between the examinations in terms of ejection fraction (EF) (p = 0.177), global longitudinal strain (GLS) (p = 0.276), circumferential strain (CS) (p = 0.238), twist (p = 0.970), or torsion (p = 0.417). CONCLUSIONS: 3D speckle-tracking-based myocardial deformation analysis from intraoperative TEE datasets is feasible in >60% of patients with aortic valve stenosis. There were no statistically significant differences in GLS, CS, twist, or torsion between the intraoperative examinations.

Spontaneous Autoamputation of Adnexa.

Introduction: Acquired ovarian torsion is an uncommon gynecologic emergency that afflicts women of reproductive age and requires correction by surgery. A rare complication of asymptomatic ovarian torsion can be necrosis and autoamputation of the adnexal structures. Case Description: A 28-year-old nulliparous woman presented with irregular menses since puberty associated with dysmenorrhea, menorrhagia, and nausea, and that did not improve with trials of oral hormone therapy. Ultrasound and pelvic MRI revealed a large, tubular-cystic mass separated from the right ovary and tubo-ovarian junction. Intraoperative findings revealed filmy adhesions and fimbriae emanating from this cystic lesion, as well as dilation of the medial portion of the right fallopian tube. Histopathology reported dilated, cystic structures with focal tubal-type epithelial lining, and a dilated fallopian tube lumen, consistent with hydrosalpinx. Discussion: Autoamputation of fallopian tube is a rare but serious complication of adnexal torsion that should be treated promptly via intraoperative detorsion.

Right cranial lung lobe torsion in a domestic ferret (Mustela putorius furo).

A 3-year-old male castrated domestic ferret presented with a 24 h history of lethargy, weakness, and anorexia. The ferret was tachypneic, painful, dehydrated, pale, and obtunded on physical examination. Radiographs and thoracic CT were utilized to diagnose a 360° right cranial lung lobe torsion (LLT) with secondary pneumothorax and pleural effusion. This was confirmed on gross necropsy and histopathology. The LLT was suspected to be secondary to previous trauma based on chronic bilateral rib fractures. Lung lobe torsions are life-threatening conditions infrequently described in veterinary medicine. Based on our review of the literature, this is the first description of an LLT in a ferret.

Oophorectomy Rates in Pediatric & Adolescent Patients with Adnexal Torsion in U.S. Emergency Departments.

OBJECTIVE: To evaluate oophorectomy rates in pediatric and adolescent patients who presented to a United States (U.S.) emergency department (ED) with adnexal torsion. METHODS: This study is a retrospective, cross sectional analysis utilizing the National Emergency Department Sample (NEDS) data from 2016 to 2018. It includes patients who are younger than 20 years old and female sex. International Classification of Diseases Version 10 (ICD-10) and ICD 10 Procedure Coding System (ICD-10 PCS) codes were utilized to define patients with adnexal torsion who underwent adnexal surgery. Descriptive statistics and multivariate logistic regression were utilized to compare oophorectomy rates by patient demographics. RESULTS: There were 263 sampled patients less than 20 years old who presented to a U.S. Emergency Department with a diagnosis of adnexal torsion and underwent adnexal surgery. Of those, 177 had an oophorectomy (67.3%). 85 had a minimally invasive surgery (48%). 15- to 19-year-olds were 2.54 times more likely to have an oophorectomy compared to 10- to 14-year-olds (95% CI: 1.42 to 4.71, Table 2). CONCLUSIONS: Despite standards for ovarian sparing surgery since 2016 and data suggestive of safety since the 1990s, oophorectomy rates remain high in pediatric and adolescent patients with torsion who present to U.S. emergency departments for care. Continued efforts should identify barriers to ovarian sparing surgeries and better quantify specific clinical nuances when oophorectomies are performed.

Acute Abdomen Accompanied by Torsion of a Segment of the Jejunum Due to Meckel's Diverticulum: A Rare and Interesting Case.

Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract and is often asymptomatic. This case report details the diagnosis and treatment of small bowel obstruction particularly in a segment of the jejunum in a 41-year-old woman due to Meckel's diverticulum. The patient presented with diffuse abdominal pain and bloating. Imaging and clinical evaluation revealed signs of ileus, leading to an exploratory laparotomy. Intraoperative findings included a mass consistent with Meckel's diverticulum causing adhesion and torsion of the jejunum. The surgical intervention involved adhesiolysis and segmental enterectomy with side-to-side anastomosis. Histopathological analysis confirmed Meckel's diverticulum with ectopic gastric mucosa. The patient had an uneventful postoperative recovery and was discharged on the seventh postoperative day.

Measurement of maize stalk shear moduli.

Maize is the most grown feed crop in the United States. Due to wind storms and other factors, 5% of maize falls over annually. The longitudinal shear modulus of maize stalk tissues is currently unreported and may have a significant influence on stalk failure. To better understand the causes of this phenomenon, maize stalk material properties need to be measured so that they can be used as material constants in computational models that provide detailed analysis of maize stalk failure. This study reports longitudinal shear modulus of maize stalk tissue through repeated torsion testing of dry and fully mature maize stalks. Measurements were focused on the two tissues found in maize stalks: the hard outer rind and the soft inner pith. Uncertainty analysis and comparison of multiple methodologies indicated that all measurements are subject to low error and bias. The results of this study will allow researchers to better understand maize stalk failure modes through computational modeling. This will allow researchers to prevent annual maize loss through later studies. This study also provides a methodology that could be used or adapted in the measurement of tissues from other plants such as sorghum, sugarcane, etc.

Wandering spleen combined with pedicle torsion and splenic infarction: a rare case report and literature review.

Wandering spleen (WS) concurrent with splenic pedicle torsion and infarction has been described rarely. We reported our experience in diagnosing and treating such a condition in a 16-year-old girl with acute abdominal pain. A plain CT scan showed the wandering of the spleen from the left upper quadrant. Contrast-enhanced CT indicated dilatation and distortion in the splenic vein, a counterclockwise "whirl sign" in the splenic pedicle, pancreatic tail torsion, and splenic infarction. The patient was diagnosed with WS combined with splenic pedicle torsion and splenic infarction and underwent splenectomy for treatment. She showed a satisfactory outcome during the follow-up. To enhance our understanding of it, we performed a comprehensive literature research to summarize the clinical manifestations, treatment options, and outcomes among adolescent patients.

Impact of Feed Bunk Space on the Prevalence of Torsion and Foreleg Distal Asymmetry in Holstein Cows.

Leg torsion and distal asymmetry (LTDA) among cows reared on intensive farms in the Comarca Lagunera region of northern Mexico may be indicative of underlying health concerns. To ascertain whether the incidence of LTDA is associated with trough measurements and with productive, reproductive, and disease variables, the prevalence of LTDA was determined in lactating dairy cows. The data were derived from two intensive dairy farms in northern Mexico (G60: 2043 cows in 13 pens with 142.0 m of linear feed bunk space and 65.0 m of pen depth; G100: 2227 cows in 12 pens with 215.0 m of linear feed bunk space and 49.0 m of pen depth). The cows were observed over the course of a week to identify any macroscopic lesions indicative of LTDA. Cows exhibiting lesions were assigned a value of "1", while those without lesions were assigned a value of "0". Furthermore, data regarding other limb diseases (LDs) were collected and subjected to analysis. A comparison was conducted to ascertain the impact of reproductive, productive, and feed bunk size variables on the prevalence of LTDA and other LDs. To ascertain the prevalence of LTDA and LDs, a chi-squared test was employed. The prevalence of LTDA was found to be 27.6% (G60: 31.4%, G100: 22.4%). No association was identified between LTDA and the variables included in the study. However, a correlation was identified between LDs and the following variables: total width, distance from the edge, width from the feed bunk to the tramp, and the presence of a manure crust on the walls. Principal component analysis (PCA) was conducted to examine the correlation between LDs and various factors at the farm and pen levels. The findings indicated that the distance from the feed bunk to the trough, the presence of manure crusts on the walls, and the breeding time were associated with LDs in G100, as well as in three of the twelve pens (302, 306, and 308) within G100. The findings suggest that the prevalence of LDs is associated with an increase in the width of the feed bunk and the width of the manure crust on the walls, particularly in pregnant cows. The results permit the conclusion that LTDA and LDs are associated with the measurements of the feed bunks, the absence of manure cleaning of the feed bunks, and gestation. This association gives rise to significant health issues for Holstein cows on these farms, with more than one in four cows affected. To reduce the prevalence of LTDA in lactating dairy cows, it is recommended that the standard measurements for feed bunk design be adhered to. This will reduce the prevalence of LTDA and LDs, promote the cleaning protocols to avoid the accumulation of manure crusts, and facilitate close monitoring of pregnant cows, thereby alleviating the impacts of these foot pathologies on animal welfare.

Unusual Presentation of Meckel's Diverticulitis Causing Small Bowel Obstruction Masquerading as Appendicitis.

Meckel's diverticulum (MD) is a prevalent congenital abnormality of the gastrointestinal tract. While it may not show any symptoms, it has the potential to cause serious complications, such as intestinal obstruction. This case report presents a case of a 27-year-old male who presented to the emergency department with migrating right lower abdomen pain and vomiting. An initial diagnosis of acute appendicitis was made. An erect X-ray of the abdomen showed features of small bowel obstruction and with a clinical suspicion of Meckel's, a diagnostic laparoscopy had been planned. However, the diagnostic laparoscopy identified a gangrenous MD with axial torsion, with an ileal loop knotting at the base of Meckel's, causing small bowel obstruction. This entanglement led to an obstruction, which is a rare and challenging clinical scenario. Surgical resection of the affected bowel segment, including the MD, was performed, leading to a complete recovery of the patient. This case study emphasizes the diagnostic difficulties presented by MD, particularly when its symptoms resemble more prevalent illnesses like appendicitis. The rare incidence of axial torsion resulting in gangrene in MD with small bowel obstruction highlights the significance of including this illness in the differential diagnosis of acute abdomen.

The Sonographic Characteristics of Isolated Fallopian Tube Torsion.

OBJECTIVE: Isolated fallopian tube torsion (IFTT) presents a challenging preoperative diagnosis. This study investigated the specific sonographic characteristics of IFTT and compared them to the characteristics of ovarian and adnexal torsion. DESIGN: Retrospective cohort study. SETTING: Tertiary level gynecological ultrasound unit.: 225 women operated for suspected isolated ovarian, fallopian tube or adnexal torsion (ovary and tube) were included. INTERVENTIONS: Electronic medical records of patients diagnosed with torsion at our ultrasound unit from 2001 to 2018 were retrieved. Inclusion criteria were women operated for suspicion of isolated ovarian, fallopian tube or adnexal torsion (involving both ovary and tube), with a preoperative sonogram performed in our tertiary level gynecologic ultrasound unit. Patients operated after a sonographic examination in the emergency department were excluded. MEASUREMENTS: Patients were divided into 4 groups according to their laparoscopic diagnosis: IFTT, ovarian torsion, adnexal torsion or no torsion. The sonographic characteristics of the groups were compared and the diagnosis was confirmed according to laparoscopy findings. MAIN RESULTS: IFTT was reported in 28/225 (12.4%) cases. Ovarian volume was significantly lower in IFTT (29.2 ± 44 cm3) compared to ovarian torsion (111 ± 143 cm3, p=.037). There were fewer cases of ovarian edema in IFTT compared to ovarian torsion (12/22 (54.5%) vs. 54/63 (85.7%) respectively, p=.001). IFTT was associated with paraovarian cyst significantly more often than with ovarian torsion (13/24 (54.2%) vs. 4/75 (5.3%), respectively; p=.003). There was no difference between whirlpool sign and location in all forms of torsion. The sensitivity, specificity, Positive predictive value and Negative predictive value for IFTT were 88.4%, 83.3%, 95.8% and 62% respectively. CONCLUSION: IFTT has distinct sonographic characteristics, including normal ipsilateral ovary, paraovarian cyst, and whirlpool sign. Awareness of these features may improve the diagnosis of IFTT and promote faster and more efficient treatment. Further studies are needed to establish these characteristics.

Splenic Torsion From a Wandering Spleen.

Wandering spleen is a unique condition defined as a hypermobile spleen with a sole attachment to its vascular pedicle. The most common complication is torsion of the spleen, resulting in a surgical emergency. Early diagnosis and prevention of splenic infarction are the mainstays of treatment to help preserve immunologic function. We report a case of torsion of the wandering spleen in a 23-year-old active-duty male with a prior childhood history of duodenal atresia. His abdominal examination demonstrated a palpable midline mass, which was confirmed by CT abdomen and pelvis to be a wandering spleen with twisting of the vascular pedicle. The patient was taken for an exploratory laparotomy, where an infarcted spleen was identified with associated twisting of the splenic hilum, and a splenectomy was performed. Post-operatively, the patient is healthy and symptom-free at the three-month follow-up and has returned to active duty.

Colonic torsion and volvulus in dogs is associated with a low mortality rate and good long-term outcome.

OBJECTIVE: To describe clinical findings, complications, and short- and long-term outcomes associated with colonic torsion and volvulus in dogs. ANIMALS: 28 client-owned dogs. CLINICAL PRESENTATION: Multi-institutional, retrospective study. Medical records were searched for dogs of any age, body weight, sex, and breed that underwent surgery for colonic torsion and volvulus. Collected data included signalment, previous history, preoperative findings, time until surgery, intraoperative findings, postoperative complications, length of hospitalization, survival to discharge, and outcomes. RESULTS: 28 dogs were included. Thirteen of 28 dogs (46.4%) had preexisting gastrointestinal conditions. Nine of 28 dogs (32.1%) had a gastropexy performed prior to presentation. Ten dogs (35.7%) were found to have a resolution of colonic torsion and volvulus at the time of the surgery. All but 1 dog (27 of 28 [96.4%]) survived to discharge. Two dogs died during the postoperative period, yielding a mortality rate of 7.1%. Postoperative complications were noted in 9 dogs (9 of 28 [32.1%]). Long-term follow-up information was available in 16 of 28 dogs (57%). Among 16 dogs with at least 6 months' follow-up, all dogs (16 of 16 [100%]) were alive at 6 months postoperatively. Two dogs developed mesenteric torsion after the initial surgery. CLINICAL RELEVANCE: Dogs with colonic torsion and volvulus undergoing surgery can have an excellent survival-to-discharge ratio with a low mortality rate. Surgeons should not be prompted to euthanize or assume a guarded prognosis solely on the basis of the intraoperative appearance of the bowel and should consider all factors prior to making decisions. Owners should be informed of the risk of developing further torsional diseases after surgery.

Investigation of the Interfacial Fusion Bonding on Hybrid Additively Manufactured Components under Torsional Load.

Hybrid manufacturing processes integrate multiple manufacturing techniques to leverage their respective advantages and mitigate their limitations. This study combines additive manufacturing and injection molding, aiming to efficiently produce components with extensive design flexibility and functional integration. The research explores the interfacial fusion bonding of hybrid additively manufactured components under torsional loading. Specifically, it examines the impact of various surface treatments on injection molded parts and the influence of different build chamber temperatures during additive manufacturing on torsional strength. Polycarbonate components, neat, with glass or carbon fiber-reinforcement, are produced and assessed for dimensional accuracy, torsional strength, and fracture behavior. The findings emphasize the critical role of surface treatment for the injection molded components before additive manufacturing. Additionally, the study identifies the influence of chamber temperatures on both dimensional accuracy and torsional strength. Among all investigated materials, plasma-treated neat samples exhibited the best torsional strength. The torsional strength was increased by up to 87% by actively heating the build chamber to 186 °C for neat polycarbonate. These insights aim to advance the quality and performance of hybrid additively manufactured components, broadening their application potential across diverse fields.

Clinical and hematological analysis of testicular torsion in children.

Purpose: Analyze the clinical manifestations, laboratory tests, and imaging data of testicular torsion to provide clinical insights for timely and accurate diagnosis and treatment of testicular torsion. Methods: A retrospective analysis was conducted on the clinical data of 67 pediatric patients suspected of testicular torsion, admitted and subjected to surgical exploration from June 2018 to June 2023. Based on whether the torsed testicle was excised during surgery, the patients were divided into orchiectomy group (40 cases) and orchidopexy group (27 cases). Combining clinical symptoms, signs, ultrasound examinations, and laboratory tests, the study aimed to summarize the influencing factors on the onset, diagnosis, and treatment of testicular torsion. Results: The clinical manifestations of all 67 pediatric patients were generally typical. Color Doppler Flow Imaging (CDFI) and surgical exploration were performed for all cases, and the results were consistent. Testicular color doppler ultrasound suggested reduced or absent blood flow, leading to surgical treatment in all cases. All patients had unilateral testicular torsion, with 46 cases (68.66%) on the left side and 21 cases (31.34%) on the right side. Intrafunicular torsion occurred in 60 cases (89.55%), while extrafunicular torsion occurred in 7 cases (10.45%). The onset distribution was as follows: 20 cases in spring, 16 cases in summer, 16 cases in autumn, and 15 cases in winter. Univariate analysis indicated significant statistical differences in age, degree of testicular torsion, duration of symptoms, NEUT, NLR, and occurrence of tunica fluid between the two groups of patients. Multivariate logistic regression analysis showed that the duration of symptoms and the occurrence of hydrocele were independent risk factors for determining testicular viability. Conclusion: Testicular torsion is more common in children and adolescents, with clinical manifestations including scrotal pain, scrotal redness and swelling, abdominal pain, nausea, and vomiting. In the early stages of testicular torsion, inflammatory markers in the blood increase, and preoperative ultrasound indicates hydrocele. This suggests that the testicle is in an early twisted state, with good viability and potential for preservation.

Multi-phased solutions of Prandtl's stress function for an orthotropic rectangular bar under Saint-Venant's torsion and the general rule of swapping.

Based on the conventional solution of Prandtl's stress function for an orthotropic rectangular bar under Saint-Venant's torsion, one can derive displacements, shear strains, shear stresses and torsional rigidity. The conventional solution of Prandtl's stress function has a hyperbolic function for the coordinate in the bar's thickness direction, and a trigonometric function for the coordinate in the width direction. This paper raises questions about the solution. Why is the solution not arranged in the opposite way? Why is the hyperbolic function not for the coordinate in the width direction and the trigonometric function for the coordinate in the thickness direction? How is it that these obvious questions have never been addressed? This study rearranges the solution of the conventional Prandtl's stress function using the TSAI technique and finds that the solution is multi-phased, indicating that the coordinates in the width and thickness directions and their corresponding parameters are swappable, a phenomenon proposed as the general rule of swapping.

A Case Report of Axial Torsion of Meckel's Diverticulum: An Acute Abdomen Without Mechanical Bowel Obstruction in a Child.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is commonly silent but can cause multiple complications. The rarest presentation of Meckel's diverticulum is axial torsion around its base without involving the main gut lumen. This can lead to acute abdomen without bowel obstruction. Here we present a case of an eight-year-old boy who was found to have a huge Meckel diverticulum with axial torsion causing necrosis of the cyst without involving the bowel's main lumen. This paper discusses potential diagnostic and therapeutic pitfalls of the axial torsion of an MD.