Ongoing transmission of onchocerciasis in the Pru District of Ghana after two decades of mass drug administration with ivermectin and comparative identification of members of the Simulium damnosum complex using cytological and morphological techniques.

BACKGROUND: Human onchocerciasis remains a public health problem in Ghana. Mass drug administration (MDA) with ivermectin (IVM) has reduced disease morbidity and prevalence, but the transmission of onchocerciasis remains ongoing in several endemic foci. We investigated parasite transmission in some endemic communities in Ghana that had received > 18 rounds of annual MDA with IVM and determined the species composition of black fly (Simulium damnosum) vectors in these areas. METHODS: Adult female black flies were collected using human landing catches and identified as either forest or savanna species using morpho-taxonomic keys. The adult flies underwent dissection to determine their parity and detect any O. volvulus larvae, followed by the calculation of entomological indices. Simulium damnosum s.l. larvae were collected and preserved in freshly prepared Carnoy's fixative and were later used for cytotaxonomic studies. RESULTS: A total of 9,983 adult flies were caught: 6,569 and 3,414 in the rainy and dry seasons respectively. Black fly biting activities over the study period showed bimodal or trimodal patterns. The highest monthly biting rate (MBR) of 10,578.75 bites/person/month was recorded in July in Beposo, while the highest monthly transmission potential of 100.69 infective bites/person/month was recorded in Asubende in August. Morphological analysis of 2,032 flies showed that 99.8% (2,028) of the flies were savanna species, with only 4 (0.2%) adult flies being of the forest species. Cytogenetic studies on 114 black fly larvae revealed three cytospecies (Simulium damnosum s.s., S. sirbanum and S. sanctipauli) in the study area. CONCLUSIONS: The present studies confirmed an ongoing transmission of onchocerciasis in the study communities except Abua-1. It also provides further information on biting behaviors and onchocerciasis transmission indices in the study communities. Further, our data confirmed the savanna species (S. damnosum s.s. and S. sirbanum) of the S. damnosum s.l. to be the major vectors of onchocerciasis in the study areas, with only an occasional influx of forest cytotypes.

Bifocal bowel obstruction by synchronous transverse and sigmoid colon volvulus: A case report and qualitative review of the literature.

INTRODUCTION: Synchronous volvulus of the transverse and sigmoid colon is an exceedingly rare clinical presentation. The dual location of strangulation constitutes a critical surgical emergency due to the heightened risk of intestinal necrosis and septic shock. Given the rarity of this condition, there is a notable paucity of detailed information in the literature, and the management strategies are poorly codified. OBSERVATION: We report the case of a 23-year-old man with a history of bowel transit disorders (diarrhea and constipation), who was admitted as an emergency with typical signs of acute large bowel obstruction. Initial diagnosis of sigmoid volvulus was retained; however, intraoperative findings revealed an associated volvulus of both the transverse and sigmoid colon. A left colectomy was performed followed by colorectal anastomosis. The postoperative period was uneventful. DISCUSSION: Synchronous volvulus of the transverse and sigmoid colon is an extremely rare occurrence; it should be considered as one of the differential diagnoses of acute large bowel obstruction. There is scarcity of information in the literature regarding synchronous sigmoid and transverse colon volvulus. CONCLUSION: Synchronous volvulus of the transverse and sigmoid colon is an exceedingly rare clinical entity. Diagnosing this condition can be difficult and the management effectiveness remains controversial. It is presumed that sigmoid volvulus is the initial event; therefore, emphasizing the need for early surgical intervention for sigmoid volvulus could potentially improve outcomes.

From Volvulus to Short Bowel Syndrome: The Impact of Extensive Gangrene.

Compound volvulus, also known as ileosigmoid knotting, is an unusual but dangerous surgical condition that causes intestinal obstruction. It is a rare condition when an area of the small intestines is twisted and interrupts the blood supply, a closed-loop obstruction that is not common for one of the causes of intestinal blockage. Still, it is essential to distinguish the difference between an ileosigmoid knot and a simple sigmoid volvulus from each other, which are managed differently. Unlike abdominal X-rays, which are often nothing but clear images, CT scans or MRIs in their place provide more precise diagnostic information to help this problem diagnosis be traced. The first step in treating the patient is to immediately do an emergency laparotomy if the case involves ileosigmoid knotting, and which specific surgical procedure to use-resectional or non-resectional-is determined by the surgeon during the operation, who is considering such scales as the extent of the affected vascular compromise, the presence of necrosis or perforation, and the overall viability of the involved intestinal loops to conduct the most sought-after therapy.  In this case, the 45-year-old male presented with insidious-onset abdominal pain, vomiting, and constipation, along with signs of dehydration and hypotension. Physical examination revealed a distended abdomen, absent bowel sounds, and elevated white blood count and lactate levels, with an erect abdominal X-ray showing a dilated bowel, suggesting acute bowel obstruction with possible ischemia. This clinical presentation is consistent with acute bowel obstruction, potentially due to ileosigmoid knotting, which requires urgent surgical intervention. Short bowel syndrome is a malabsorptive disorder characterized by the presence of less than 200 cm of the small bowel, sometimes as a result of congenital or surgical causes. This is a real problem for an individual because he or she must be cautious and watch what they eat and how much they eat fortified foodstuffs, as the decreased absorptive capability of the small intestine can restrict the body's ability to take in and make use of necessary nutrients, fluids, and electrolytes.

Diaphragmatic rupture due to massive gastric volvulus after robotic-assisted diaphragm plication.

Gastric volvulus has been rarely associated with diaphragmatic paralysis or eventration. In this article, we present the case of a patient with idiopathic paralysis of the left hemidiaphragm that underwent treatment with a robotic thoracoscopic diaphragm plication, which was complicated by massive gastric volvulus resulting in such significant intra-abdominal hypertension that the ipsilateral diaphragm ruptured anterior to the plication suture line.

Double ileo-sigmoid volvulus: Report of three (03) cases of ileo-sigmoid node.

INTRODUCTION: The ileo-sigmoid node is a rare condition that causes mixed intestinal obstruction. It is difficult to diagnose preoperatively and requires medical and surgical management. We report on managing 03 cases of the ileo-sigmoid node. CASE PRESENTATION: 02 male patients (25 and 37 years old) and one female patient (43 years old) were seen in emergency for occlusive syndromes. The abdominal X-rays in our patients showed air-fluid levels of the small intestine type in two cases and of the mixed type in one case. The diagnosis of intestinal obstruction by strangulation was accepted in all three patients. Hypovolaemic shock was found in the female patient. All three patients had received preoperative resuscitation. Laparotomy revealed type II ileo-sigmoid nodes in 02 cases and type I in one. We noted ileal and sigmoid necrosis in 02 cases and ileal necrosis in 01 case. All three patients underwent ileal and sigmoid resection followed by colorectal anastomosis and terminal ileostomy. Post-operative management was straightforward in all the 03 cases. CLINICAL DISCUSSION: The ileo-sigmoid node is a serious pathological situation, with the risk of rapid evolution of the intestines involved. It is a medical and surgical emergency requiring rapid and appropriate treatment. CONCLUSION: The ileo-sigmoid node is a serious condition with a complex preoperative diagnosis. It is a medical and surgical emergency requiring rapid and appropriate management.

Prenatal ultrasound diagnosis of fetal volvulus without malrotation: A case report.

Cases of fetal volvulus without malrotation are extremely uncommon and pose a life-threatening condition of acute abdomen. In cases of inadequate intestinal rotation, the narrowing of the attachment of the mesenteric root can easily cause intestinal torsion and consequent local blood circulation disorders within the intestinal tract, leading to aseptic necrosis and simultaneous intestinal perforation, resulting in meconium peritonitis, ascites, anemia, and potentially fetal death. In ultrasound examinations, it may be the preferred examination method for this disease. Ultrasound physicians should improve their understanding of this disease in prenatal diagnosis, as it has important clinical value for obstetric management and neonatal treatment, thereby potentially improving adverse pregnancy outcomes.

Acute Gastric Volvulus: A Rare Complication of Hiatal Hernia.

Gastric volvulus, characterized by stomach rotation, is a rare condition arising from congenital or acquired factors. Predominantly affecting pediatric and elderly populations, it necessitates a high index of suspicion for timely diagnosis. Delayed recognition may precipitate severe complications such as ischemia, strangulation, and septic shock, often culminating in fatal outcomes. We present a case of a 71-year-old male initially admitted for suspected gastroenteritis, subsequently developing acute gastric volvulus during hospitalization, necessitating immediate surgical intervention. This case contributes to the scant literature on gastric volvulus in the elderly demographic.

Malrotation with mid-gut volvulus and partial small bowel peritoneal membrane encapsulation.

Urgent investigation is crucial for infants with bilious vomiting, potentially indicating bowel obstruction. Upper gastrointestinal fluoroscopy aids diagnosis, but is not without its challenges. This case report describes a rare case of neonatal intestinal malrotation and mid-gut volvulus with an additional complication of congenital peritoneal encapsulation. Contribution: This case study offers insights into associated diagnostic challenges and underscores the value of utilising fluoroscopy in diagnosing complex gastrointestinal conditions.

No small dilemma: small bowel volvulus mimicking acute coronary syndrome.

Acute abdominal pathologies can cause electrocardiogram (ECG) changes mimicking an acute coronary syndrome (ACS), resulting in diagnostic uncertainty and delay. We report a 65-year-old male with multiple risk factors for ACS who presented with four hours of progressive epigastric and chest pain that resolved in the emergency department. ECG findings were concerning for new deeply inverted T-waves with normal troponins, raising concerns for Wellens Syndrome. Emergent heart catheterization was negative but abdominal computed tomography angiography showed occlusion of the superior mesenteric vessels. Subsequent exploratory laparotomy revealed a small bowel volvulus with extensive necrosis, resulting in a 430 cm resection.

Sigmoid Volvulus in the Setting of Type 4 Hiatal Hernia: An Uncommon Presentation and Literature Review.

Hiatal hernias occur when intra-abdominal contents protrude into the diaphragmatic opening. Of the four classifications, Type 4 hiatal hernias are the most rare and severe. They develop from herniation of the gastroesophageal junction and abdominal viscera other than the stomach into the thoracic cavity. The resulting increase in intrathoracic pressure can cause a wide variety of symptoms on presentation and potentially lead to misdiagnosis. We present a rare case in which a 78-year-old woman presented with nonspecific symptoms and was diagnosed with incarcerated Type 4 hiatal hernia with sigmoid volvulus. We also report a literature review from 2015 to emphasize the importance of recognizing diverse symptomatic presentations in complex Type 4 hiatal hernias and the need for a comprehensive evaluation, as early detection and prompt intervention are essential in preventing life-threatening complications.

Endometriosis of the Colon and Pericolic Lymph Nodes Presenting as Cecal Volvulus.

Endometriosis, characterized by the ectopic implantation of endometrial tissue, typically involves pelvic structures but infrequently extends to extrapelvic sites such as the gastrointestinal tract. In this report, we present a case of a 44-year-old woman with diffuse abdominal discomfort and constipation. Computed tomography imaging revealed a mass in the cecum, leading to diagnostic colonoscopy and subsequent magnetic resonance imaging. Ultimately, laparoscopy revealed a puckered cecal mass suspected to be invasive malignancy but pathologically confirmed as extensive endometriosis involving the colonic wall and pericolic lymph nodes. Cecal volvulus secondary to endometriosis is exceedingly rare, with surgical intervention being the primary treatment modality. Endometriosis-associated gastrointestinal involvement often masquerades as irritable bowel syndrome, highlighting the importance of considering atypical presentations in young women. This case underscores the need to maintain a high index of suspicion for unusual etiologies in patients with gastrointestinal symptoms and atypical imaging findings to facilitate timely diagnosis and management.

Coexisting Organoaxial Gastric Volvulus and Sigmoid Volvulus With Complications.

Very few cases of coexisting organoaxial gastric and sigmoid volvuli have been reported. In here we describe 1 such case. Our patient, a 92-year-old man, was treated with a flexible sigmoidoscopy with decompression for his sigmoid volvulus. For the gastric volvulus, the patient was initially treated with an upper endoscopic gastric decompression and subsequently treated with a laparoscopic anterior gastropexy. After the gastropexy, the patient developed bleeding and ischemia of the stomach, which is a rare complication due to the stomach's rich blood supply. This case report reiterates the need to consider rare complications in patients with such rare pathologies.

Flowmetry and spectrophotometry can detect reduced intestinal microperfusion in nonsurvivors during equine colic surgery for large intestinal strangulation.

OBJECTIVE: To evaluate the use of laser Doppler flowmetry and spectrophotometry (LDFS) for large intestinal viability assessment in horses with naturally occurring large intestinal strangulations. METHODS: By use of LDFS, intestinal microperfusion was quantified as tissue oxygen saturation (tSo2), hemoglobin (tHB), and blood flow (tBF) in cases with large colon volvulus and small colon strangulations undergoing colic surgery (n = 17). Intestinal biopsies were taken from the pelvic flexure in all large colon cases and in small colon cases that underwent intraoperative euthanasia. Measurements were compared between survivors and nonsurvivors, and the correlation between LDFS and (immuno)histology was tested (P < .05). RESULTS: The tSo2 and tBF were clearly lower and tHB was higher than previously reported in healthy horses. Following correction of the lesion, pelvic flexure tBF was significantly lower than that of the left ventral colon. Prior to correction of the lesion, microperfusion did not differ between survivors and nonsurvivors, but following release of the strangulation the survivors had a significantly higher tSo2 and tBF compared to the nonsurvivors. There was a negative correlation between tBF and interstitium-to-crypt ratio and a positive correlation between tHB and the histological hemorrhage score. There were no significant correlations between LDFS measurements and inflammatory cell counts or hypoxia-inducible factor-1α immunoreactivity. CONCLUSIONS: Large intestinal microperfusion was decreased in nonsurvivors compared to survivors and was correlated with histological injury, suggesting that LDFS has the potential to predict tissue injury and postoperative survival. CLINICAL RELEVANCE: The use of LDFS as an ancillary diagnostic aid may improve intraoperative viability assessment during colic surgery.

Endoscopic detorsion of sigmoid volvulus in a young female: a case report.

BACKGROUND: A volvulus refers to the torsion or rotational twisting of a portion of the gastrointestinal tract, with a predilection for impacting the caecum and sigmoid colon, often resulting in the development of bowel obstruction. The risk factors associated are old age, chronic fecal impaction, psychiatric disorders, colonic dysmotility, prior abdominal surgical procedures, diabetes, and Hirschsprung's disease. Elderly are most commonly affected with sigmoid volvulus but there are few cases among young adults that culminate in grave complications. Although it is rare, but young individuals presenting with acute abdomen secondary to sigmoid volvulus need urgent attention. To prevent more invasive surgical procedures, endoscopic detorsion is preferred nowadays with complete recovery of patients. We present a case of young female who was successfully managed with endoscopic detorsion. CASE PRESENTATION: 27 years old Asian Pakistani female presented with worsening abdominal distention, constipation and vomiting since 2 days. On examination she was afebrile, vitally stable. Abdomen was distended, tympanic percussion with generalized tenderness. Abdominal radiograph was obtained which showed dilated bowel loops followed by Computed tomography of abdomen which was suggestive of Sigmoid volvulus causing intestinal obstruction. Patient was immediately moved to endoscopy unit and endoscopic detorsion of volvulus was done. For individuals who present with sigmoid volvulus and do not exhibit signs of peritonitis or colonic gangrene, the recommended course of action involves acute endoscopic detorsion, followed by scheduled surgical intervention. CONCLUSION: This case report emphasizes the significance of clinicians considering sigmoid volvulus as a rare but important cause when evaluating abdominal pain in young and otherwise healthy patients. A delay in diagnosis and treatment extending beyond 48 hours leads to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.

Laparoscopic Versus Open Ladd Procedure for Midgut Malrotation.

INTRODUCTION: Intestinal malrotation is an uncommon developmental anomaly that can lead to duodenal obstruction and midgut volvulus. The standard correctional operation, Ladd's operation, is traditionally performed using an open approach, but providers are increasingly performing the procedure laparoscopically. However, there remains concern that the reduced adhesive burden associated with laparoscopy could predispose to recurrent volvulus. METHODS: We queried our institutional database from 2012 to 2022 for patients <18 years who underwent Ladd's operation for malrotation. We analyzed baseline characteristics and outcomes including post-operative volvulus, adhesive small bowel obstruction (SBO), duodenal obstruction, and overall abdominal re-operation. RESULTS: We identified 226 patients, of whom 90 (40%) underwent a laparoscopic operation. Those undergoing open surgery were younger and had a higher rate of volvulus compared to laparoscopic patients. There were no differences in surgical history or underlying comorbidities. Laparoscopic patients were less likely to develop a post-operative adhesive SBO [1/90 (1%) vs 14/136 (10.0%); OR 9.4 (1.7-176.4), p = 0.036] with no increased rate of volvulus [1/90 (1%) vs 1/136 (0.7%), p = 0.778]. However, there were four laparoscopic patients that required re-operation for a duodenal stricture or kink, which led the overall rate of abdominal re-operation to not be different [7/90 (8%) vs 16/136 (12%); OR 1.6 (0.6-4.8), p = 0.371]. Median follow up was 2.3 years [IQR 1.0-5.0]. CONCLUSION: Laparoscopic correction of midgut malrotation demonstrates no increased risk of post-operative volvulus and may reduce the rate of adhesive SBO. These benefits must be weighed against the potential increased risk of duodenal stricture or obstruction secondary to an incomplete Ladd's procedure. LEVEL OF EVIDENCE: III.

Inference of essential genes in Brugia malayi and Onchocerca volvulus by machine learning and the implications for discovering new interventions.

Detailed explorations of the model organisms Caenorhabditis elegans (elegant worm) and Drosophila melanogaster (vinegar fly) have substantially improved our knowledge and understanding of biological processes and pathways in metazoan organisms. Extensive functional genomic and multi-omic data sets have enabled the discovery and characterisation of 'essential' genes that are critical for the survival of these organisms. Recently, we showed that a machine learning (ML)-based pipeline could be utilised to predict essential genes in both C. elegans and D. melanogaster using features from DNA, RNA, protein and/or cellular data or associated information. As these distantly-related species are within the Ecdysozoa, we hypothesised that this approach could be suited for non-model organisms within the same group (phylum) of protostome animals. In the present investigation, we cross-predicted essential genes within the phylum Nematoda - between C. elegans and the parasitic filarial nematodes Brugia malayi and Onchocerca volvulus, and then ranked and prioritised these genes. Highly ranked genes were linked to key biological pathways or processes, such as ribosome biogenesis, translation and RNA processing, and were expressed at relatively high levels in the germline, gonad, hypodermis and/or nerves. The present in silico workflow is hoped to expedite the identification of drug targets in parasitic organisms for subsequent experimental validation in the laboratory.

Twists and Turns: Gallbladder Volvulus in an Elderly Patient.

Gallbladder volvulus (GBV) is a rare medical condition characterized by twisting of the gallbladder around its mesentery. The condition presents with a higher prevalence in older, thin, elderly women and is a challenging diagnosis with nonspecific symptoms often overlapping with acute cholecystitis. Early diagnosis and intervention are critical to prevent complications including ischemia, necrosis, gangrene, perforation, or sepsis. This case is about a 94-year-old woman who presented with epigastric and right upper quadrant pain, nausea, and vomiting with non-specific laboratory results and radiographic findings, leading to an intraoperative diagnosis of GBV. This report underscores the importance of considering GBV in differentials for acute abdominal signs and symptoms and the challenges in diagnosing GBV preoperatively due to its non-specific presentation and, in this case, unrevealing laboratory findings.