Chronic jejuno-colonic fistula and intestinal malabsorption due to multiple magnet ingestions: A case report and systematic review.

Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.

Jejunal Diverticulosis Causing Small Intestinal Volvulus and Closed Loop Obstruction.

BACKGROUND Jejunal diverticulosis are false diverticula of the small bowel that form from outpouching of the mucosa and submucosa. They are pulsion diverticula that are often asymptomatic and can be found incidentally during surgery. In some instances, jejunal diverticula could result in intestinal obstruction. Small intestinal volvulus is an uncommon cause of small bowel obstruction that results in a closed loop obstruction and is an indication for emergent surgical intervention. CASE REPORT We report a case of an 84-year-old man who presented to the Emergency Department with abdominal pain and generalized weakness. A preoperative computerized tomographic scan demonstrated a closed loop small bowel obstruction with mesenteric swirling. The patient was taken for a diagnostic laparoscopy, which revealed extensive proximal jejunal diverticulosis and a volvulus of the involved jejunum. An exploratory laparotomy was warranted for safe detorsion of the small bowel and resection of the diseased segment. The small bowel was successfully detorsed, with resection of the involved jejunum. Intestinal continuity was established by a primary side-to-side anastomosis. CONCLUSIONS Jejunal diverticula have been reported in the literature as a cause of small bowel obstructions, and very few reports exist of concurrent small bowel volvulus. In very rare instances, both of these conditions can coexist. There should be prompt surgical intervention in all cases of closed loop small bowel obstructions to prevent intestinal ischemia, perforation, and sepsis.

Roux-en-Y partial volvulus in biliary-digestive reconstruction in children.

Various complications occur after a biliary-digestive reconstruction. Volvulus of a segment of the biliodigestive loop has not been described. Two patients who underwent biliodigestive bypass, years later, began with sudden and intense abdominal pain, associated with a volvulus with necrosis of a segment of this biliodigestive loop. This complication occurred many years after the initial correction, and manifested with sudden abdominal pain without impaired liver function, as occurred in these patients.

Diversas complicaciones pueden ocurrir después de una reconstrucción biliodigestiva. El vólvulo de un segmento del asa biliodigestiva no ha sido descrito. Dos pacientes operados de derivación biliodigestiva, años después iniciaron con dolor abdominal súbito e intenso, asociado a un vólvulo con necrosis de un segmento de la asa interpuesta. Se ha descrito el vólvulo de toda el asa interpuesta, pero no el de solo una pequeña porción de esta. La complicación ocurrió muchos años después de la corrección inicial y se manifiesto con dolor abdominal súbito sin deterioro de la función hepática, como sucedió en estos pacientes.

Embarazo con miomatosis uterina complicado con isquemia intestinal: reporte de un caso / Pregnancy with uterine myomatosis complicated by intestinal ischemia: case report

Resumen Los miomas uterinos, también conocidos como fibromas o leiomiomas, son los tumores uterinos benignos más prevalentes. Afectan a las mujeres principalmente durante sus años reproductivos y se diagnostican hasta en un 70% de las mujeres blancas y en más del 80% de las mujeres de ascendencia africana durante su vida, con una prevalencia durante el embarazo del 2% al 10%. Pueden ser asintomáticos hasta en un 70% de las pacientes, y se estima que pueden ocurrir complicaciones en aproximadamente una de cada 10 mujeres embarazadas. Se han asociado a complicaciones y resultados adversos del embarazo, según su tamaño y ubicación en el útero, y pueden manifestarse de diferentes formas. Presentamos el caso de una mujer de 30 años, con embarazo en el tercer trimestre, quien consultó por dolor abdominal, con ecografías obstétricas durante su control prenatal que reportaban miomatosis uterina, quien presentó isquemia intestinal por un vólvulo de intestino delgado versus compresión extrínseca.

Abstract Uterine fibroids, also known as fibroids or leiomyomas, are the most prevalent benign uterine tumors, affecting women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African descent during their lifetime, with a prevalence during pregnancy of 2% to 10%; they may be asymptomatic in up to 70% of patients, and it is estimated that complications may occur in approximately one in 10 pregnant women. They have been associated with complications and adverse pregnancy outcomes, depending on their size and location in the uterus, they can manifest in different ways. We present the case of a 30-year-old woman, pregnant in the third trimester, who consulted for abdominal pain, with obstetric ultrasound scans during her prenatal check-up reporting uterine myomatosis, who presented intestinal ischemia due to small bowel volvulus versus extrinsic compression.

Vólvulo de ciego secundario a brida epiploica entre colon transverso y anillo inguinal interno izquierdo / Cecal volvulus secondary to epiploic bridle between transverse colon and left internal inguinal ring

El vólvulo cecal es una causa poco frecuente de oclusión intestinal. Generalmente, es causado por exceso de movilidad del ciego. Aunque existen múltiples causas desencadenantes, la presencia de una brida epiploíca sin antecedentes de cirugía abdominal, constituye una etiología excepcional. La presentación clínica es inespecífica y el diagnóstico se confirma mediante TC de abdomen. Presenta un alto índice de mortalidad si no se diagnostica de manera precoz. El abordaje mínimamente invasivo constituye el trata-miento de elección. Presentamos el caso de una paciente de 96 años de edad sin antecedentes de cirugía abdominal, que presentó un cuadro de oclusión intestinal debido a vólvulo cecal secundario a brida epiploíca entre colon transverso y anillo inguinal profundo izquierdo, que requirió una hemicolectomía derecha abierta de urgencia. Realizamos una revisión de los aspectos relacionados con la etiología, fisiopatología, manifestaciones clínicas, diagnóstico y tratamiento

Cecal volvulus is a rare cause of intestinal occlusion. Generally, it is caused by excess mobility of the blind. Although there are multiple triggers causes, the presence of an epiploic bridle without a history of abdominal surgery constitutes an exceptional etio-logy. The clinical presentation is nonspecific and the diagnosis is confirmed by abdominal CT. It has a high mortality rate if it is not diagnosed early. The minimally invasive approach constitutes the treatment of choice. We present the case of a 96-year-old patient withouth a history of abdominal surgery, who presented an acute cecal volvulus secondary to an epiploic bridle between the transverse colon and left internal inguinal ring, which required an emergency right hemicolectomy. We review the aspects related to etiology, physiopathology, clinical manifestations, diagnosis and treatment

Síndrome de Chilaiditi complicado con vólvulo de sigma y desplazamiento hepático / Chilaiditi syndrome complicated by a sigmoid volvulus and hepatic displacement

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Megacolon andino y vólvulo del sigmoides de la altura: Presentación de 418 casos entre 2008 - 2012 en el hospital C. Monge - Puno, Perú / Andean megacolon and sigmoid volvulus in the high altitude: Presentation of 418 cases between 2008 - 2012 at C. Monge Hospital, Puno, Peru

Objetivo: El presente estudio describe el manejo médico y quirúrgico del vólvulo de sigmoides debido a dolicomegacolon andino en un hospital a una altitud mayor a 3000 msnm. Material y métodos: Estudio descriptivo, observacional, transversal de 418 pacientes con diagnóstico de vólvulo de sigmoides; admitidos inicialmente por cuadros de obstrucción intestinal, en el Hospital de Juliaca Carlos Monge - Puno, Perú, durante el periodo 2008-2012. Los datos fueron procesados a través del programa SPSS versión 21. Resultados: Se registraron 418 pacientes, la media de edad fue de 60 años, rango 18-89 años, con una proporción hombre/mujer de 3,5/1. El manejo no quirúrgico se hizo en 64 (15,4%), el tratamiento empleado fue de enema salino 20 casos 31% y sonda rectal 44 (69%), se presentó recurrencia en 27 pacientes (45%), los cuales tuvieron cirugía con resección anastomosis primaria, de estos la mortalidad correspondió a 8 pacientes (30%). De los 354 pacientes sometidos a manejo quirúrgico de emergencia 325 fueron sometidos a sigmoidectomia con anastomosis primaria (92%), mientras 29 tuvieron colostomía a lo Hartmann (8%), la morbilidad para ambos procedimientos fue de 52 casos (14,7%), la mortalidad para ambos procedimientos fue de 45 casos (12,7%). Conclusiones: El vólvulo sigmoides debido a megacolon andino tuvo una edad media de 60 años. El 15,4% tuvo manejo no quirúrgico, la tasa de recurrencia fue de 45%, mortalidad de 30%. El 84,7% tuvo manejo quirúrgico; el 92% tuvo resección anastomosis primaria y 8% colostomía a lo Hartmann, la morbilidad fue de 14,7% y la mortalidad de 12,7%.

Objective: The present study describes the medical and surgical management of sigmoid volvulus due to Andean dolicomegacolon in a hospital at an altitude above 3000 m. Material and methods: A descriptive, observational, crosssectional study of 418 patients diagnosed with sigmoid volvulus; Admitted initially due to intestinal obstruction, in the Hospital of Juliaca Carlos Monge. Puno-Perú, during the period 2008-2012. The data were processed through the SPSS software version 21. Results: A total of 418 patients were enrolled, the mean age was 60 years, range 18-89 years, and the male/female ratio was 3.5/1. Nonsurgical management was done in 64 (15.4%), the treatment used was saline enema 20 cases (31%) and rectal catheter 44 (69%), recurrence was present in 27 patients (45%), who had surgery with primary anastomosis resection, of which the mortality corresponded to 8 patients (30%). Of the 354 patients undergoing emergency surgical management, 325 were submitted to sigmoidectomy with primary anastomosis (92%), while 29 had Hartmann's colostomy (8%), the morbidity for both procedures was 52 cases (14.7%), Mortality for both procedures was 45 cases (12.7%). Conclusions: In patients with sigmoid volvulus due to Andean megacolon the mean age was 60 years. The 15.4% had non-surgical management, the recurrence rate was 45%, and mortality 30%. Patients with surgical management was 84.7%, from this group; 92% had primary anastomosis resection and 8% Hartmann colostomy, morbidity was 14.7% and mortality was 12.7%.

Vólvulo de sigmoides en el puerperio / Sigmoid volvulus in the puerperium

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Vólvulo intestinal secundario a duplicación yeyunal / Intestinal volvulus due to yeyunal duplication

La duplicación intestinal (DI) es una malformación congénita rara que puede aparecer en todo el tracto digestivo, siendo la localización más frecuente el íleon. Muchas de ellas se diagnostican de forma incidental. Sin embargo, algunos pacientes presentan una combinación de dolor y síntomas obstructivos o complicaciones como obstrucción intestinal (vólvulo, invaginación o compresión extrínseca), hemorragia y/o perforación. Presentamos el caso de una paciente con dolor abdominal intermitente de dos meses de evolución que se asociaba a vómitos. La analítica de sangre fue normal y en las pruebas radiológicas (ecografía y resonancia magnética) se objetivó una imagen quística acompañada de vólvulo intestinal. La paciente fue sometida a una laparotomía en la que se realizó devolvulación y exéresis de los quistes. El dolor abdominal es causa frecuente de consulta. Entre las causas posibles, deben tenerse presentes etiologías no tan frecuentes pero potencialmente graves como las malformaciones digestivas y sus complicaciones

Duplications of the alimentary tract are congenital malformations. The ileum is the most commonly affected organ. A lot of duplications are incidentally diagnosed but most of patients present a combination of pain or complications such as obstructive symptoms, intestinal intussusception, perforation or volvulus. We report the case of a 6-years-old girl, with intermittent abdominal pain and vomits for two months long. Laboratory work was completely normal and in the radiology analysis (abdominal sonography and magnetic resonance) a cystic image with intestinal volvulus was observed. The patient underwent laparotomy, Ladd’s procedure was done and the cyst was resected. In conclusion, if a patient is admitted with abdominal pain and obstructive symptoms, it is important to consider duplication of the alimentary tract as a possible diagnosis

Midgut volvulus after laparoscopic appendectomy / Volvo de intestino delgado após apendicectomia laparoscópica

The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.

Relato do caso de uma criança de 13 anos de idade submetida à apendicectomia laparoscópica e que, no pós-operatório, desenvolveu quadro de obstrução intestinal, decorrente de um volvo de intestino delgado, na ausência de má rotação intestinal.

Linfangioma mesentérico multiquístico como causa de vólvulo intestinal / Mesenteric lymphangioma causing volvulus: report of one case

Lymphangiomas are rare benign lesions, most commonly seen in children and adolescents. Their intra-abdominal presentation is uncommon. We report a 19 years old male, presenting to the emergency room with abdominal pain associated with fever, vomiting and abdominal distension. There was a history of multiple previous consultations for abdominal pain. A plain abdominal X-ray examination suggested a bowel obstruction. At surgery a volvulus and dilation of the small bowel in relation to a vascular malformation was found, excising 40 cm of jejunum with an end-to-end intestinal anastomosis. The pathology report showed a Mesenteric Multicystic Lymphangioma. Presently, the patient is in good conditions.

Los linfangiomas son lesiones benignas, de baja incidencia, más comunes en niños y adolescentes. Con muy baja frecuencia son intraabdominales y poseen presentación clínica variable, yendo desde el hallazgo clínico hasta pacientes con riesgo vital por abdomen agudo. Presentamos el caso de un paciente de 19 años, sin antecedentes mórbidos que acude a urgencias por dolor abdominal asociado a fiebre, vómitos y distensión abdominal; la radiografía simple es sugerente de obstrucción intestinal. En laparotomía exploradora se encuentra un vólvulo y dilatación del intestino delgado en relación a una malformación vascular y lesiones multilobuladas en mesenterio. Se resecan 40 cm de yeyuno y realiza anastomosis término-terminal. La histología reveló un Linfangioma Multiquístico Mesentérico. El paciente evoluciona en buenas condiciones generales y se mantiene control clínico e imagenológico seriado. Aunque infrecuente, es uno de los diagnósticos diferenciales de abdomen agudo. A pesar de su naturaleza benigna puede llegar a comprometer el pronóstico vital del paciente.

Manejo quirúrgico del vólvulo de sigmoides en el Hospital Departamental de Huancavelica durante el periodo 2004-2007 / Surgical management of sigmoid volvulus at the Departmental Hospital of Huancavelica during the period 2004-2007

El vólvulo de sigmoides es una emergencia frecuente en los hospitales del área andina, donde representa más del 50 por ciento de todas las obstrucciones intestinales. El Dolicomegacolon Andino (DCMA) y la mesocolonitis retráctil son los principales factores predisponentes del vólvulo; la mesocolonitis aproxima el segmento proximal y distal del asa sigmoidea, favoreciendo su torsión. La ingesta copiosa de alimentos fermentables constituye el factor precipitante del vólvulo; la mayoría de los pacientes son atendidos durante las épocas de cosecha y siembra, períodos en los que aumenta su consumo. Los andinos que viven sobre los 3,000 metros de altura tienen el colon de mayor longitud y diámetro que los habitantes del llano, ésta característica adquirida la llamamos el Dolicomegacolon Andino (DCMA). El alto contenido de fibra dietaria inhibiría el fenómeno histológico denominado elastogénesis, induciendo a los largo de los años el megacolon. El objetivo principal del presente trabajo es evaluar los resultados de las técnicas quirúrgicas empleadas en pacientes con diagnóstico de vólvulo de sigmoides en el Hospital Departamental de Huancavelica-MINSA, durante el periodo 2004-2007. La edad de los pacientes fluctúa entre los 19 y los 76 años de edad, siendo más frecuente en el grupo etario de 40 a los 60 años, asimismo se ve que el cuadro se presenta con mayor frecuencia en el sexo masculino siendo la proporción de 4 a 1 en relación a los pacientes de sexo femenino. El número de pacientes con diagnóstico de vólvulo de colon fueron en total 161 de los cuales se realizaron resección y anastomosis primaria en 134 casos y procedimiento de Hartmann en 27 casos. La complicación más frecuente fue la infección de herida operatoria en 5 casos en pacientes sometidos a resección y anastomosis primaria y 2 casos en pacientes que fueron sometidos a procedimiento de Hartmann. Seguida de infección respiratoria y dehiscencia de anastomosis en 2 casos en pacientes sometidos a...

Sigmoid volvulus is a common emergency in hospitals in the Andean region, accounting for over 50 per cent of all intestinal obstructions. The Andean dolichomegacolon (DCMA) and retractile mesocolonitis are the main predisposing factors for volvulus; mesocolonitis brings the proximal and distal segment closer to the sigmoid loop, favoring a twist. Massive intake of fermentable food is the precipitating factor for volvulus. Most patients are seen during harvest and sowing seasons which are the periods when intake increases. Andean people who live above 3.000 meters have a longer and wider colon than inhabitants of the plain. This characteristic is called Andean dolichomegacolon (DCMA). The high content of dietary fiber inhibiting the histological phenomenon is known as elastogenesis, and over the years leads to megacolon. The main objective of this work is to evaluate the results of the surgical techniques used in patients with a sigmoid volvulus diagnosis in the Department Hospital of Huancavelica, Ministry of Health, during the period of 2004 - 2007. Patients' age range from 19 to 76 years old and it is more common to find in the 40 to 60 age group. Also, it is more frequently seen in male than female patients, on a 4 to 1 ratio. The number of patients diagnosed with colon volvulus were 161 in total, of which 134 cases underwent primary resection and anastomosis, and Hartmann's procedure was performed on 27 cases. The most common complication was operation wound infection in 5 cases in patients undergoing primary resection and anastomosis and in 2 cases on patients who underwent Hartmann's procedure. The next most frequent complication was respiratory infection and dehiscence of anastomosis in 2 cases on patients undergoing primary resection and anastomosis, and 2 cases in patients who underwent Hartmanns procedure. As to mortality of this condition, according to the results obtained in the present study, 2 patients who underwent primary resection and...

Chronic Recurrent Volvulus of the Colonic Splenic Flexure Associated with the Eventration of Left Diaphragm / 대한소화기학회지

The eventration of diaphragm is usually found incidentally on chest X-ray or sometimes presented as acute gastric volvulus. However, colonic volvulus on splenic flexure area complicated by diaphragmatic eventration is extremely rare. A 25 year old man complained of upper abdominal pain for three days. He had a history of brain injury during infant period, and had epilepsy and mental retardation. Plain chest X-ray showed left diaphragmatic eventration and marked dilatation of colon on splenic flexure area which had not been changed for last three years. Barium enema showed bird beak appearance on distal colon near the splenic flexure. Colonoscopic reduction failed. After decompression with rectal and nasogastric tubes, colonic volvulus was relieved. To prevent the recurrence of volvulus, we performed segmental resection of left colon including splenic flexure area and repaired the left diaphragmatic eventration. After the operation, the patient had no further recurrent episode of volvulus although ileus persisted.

Úlceras em megacólons chagásicos operados na urgência e eletivamente / Ulcerations in Chagas' megacolon operated at urgency and electively

RACIONAL: O megacólon é uma doença freqüente no nosso meio e abordado na urgência pelas suas complicações como fecalomas, volvos e perfurações. As úlceras de estases nos megacólons contribuem como prováveis sítios de perfurações OBJETIVO: Comparar as freqüências de úlceras de decúbito em megacólons chagásicos operados na urgência, por volvo e fecaloma, e eletivamente, objetivando melhor conduta cirúrgica na urgência MATERIAL E MÉTODOS: Analisaram-se os laudos de 356 exames anatomopatológicos de ressecções colônicas de pacientes operados por megacólon chagásico na urgência (102 casos; 29 por cento) e eletivamente (254 casos; 71 por cento), no período de 1980 a 2000. As indicações cirúrgicas de urgência foram atribuídas a volvo (71 casos; 69,6 por cento), fecaloma (25 casos; 24,5 por cento), abdome agudo perfurativo após sondagem retal ou sigmoidoscopia (6 casos; 5,9 por cento). Compararam-se as freqüências de úlceras nos dois grupos de peças cirúrgicas, com a utilização do teste do qui-quadrado RESULTADOS: Nos laudos das peças cirúrgicas obtidas nas cirurgias de urgência, constatou-se o registro de úlceras em 26 casos (25,5 por cento); nas peças de ressecções eletivas verificaram-se úlceras em 21 casos (8,25 por cento). A diferença observada foi estatisticamente significante. A comparação dos grupos de volvo, fecaloma e volvo com fecaloma, em separado com o grupo das cirurgias eletivas, evidenciou diferenças significantes em relação ao volvo e ao fecaloma CONCLUSÃO: A freqüência muito maior de úlceras nos megas operados em caráter de urgência enfatiza a necessidade da ressecção imediata do cólon sigmóide, ao invés da conduta conservadora de simples colostomia descompressiva, mesmo naquelas laparotomias exploradoras em que o exame macroscópico do sigmóide não mostre sinais de necrose. Desta forma, deve-se prevenir a ocorrência de perfuração do megacólon no pós-operatório mediato, com conseqüências usualmente graves.

BACKGROUD: The megacolon is a frequent disease in our emergencie hospital, and approached in the urgency by your complications as fecal impaction, volvulus and perforations. The ulcerations in the megacolons contribute as probable sites of perforations AIM: To compare the frequencies of stercoral ulceration in Chagas' megacolon operated at urgency, by volvulus or fecal impaction, and electively, aiming at a better surgical conduct in the urgency surgery METHODS: It was analyzed 356 anatomy-pathological exams from colon resection of operated patients due to Chagas' megacolon at urgency (102 cases; 29 percent) and electively (254 cases; 71 percent), from 1980 to 2000. The surgical urgency indications were attributed to volvulus (71 cases; 69,6 percent), fecal impaction (25 cases; 24,5 percent), perforated acute abdomen after rectal catheter or sigmoidoscopy (6 cases; 5,9 percent). The ulceration frequency was compared in both groups of resections, using chi-square RESULTS: The pathological anatomy - of surgery resection obtained at urgency surgeries, showed 26 cases of ulceration (25,5 percent) and in electively resections were verified 21 cases of ulceration (8,25 percent). The difference observed was statistically significant. The comparison among the groups of volvulus; fecal impaction and volvulus with fecal impaction, separately with electively surgery group evidenced significant differences in relation to volvulus and fecal impaction CONCLUSIONS: The higher frequency of ulcerations in the megacolon operated at urgency character emphasizes the needs of immediate resection of sigmoid colon, instead of conservative conduct of simple decompression colostomy, even in exploration laparotomy which the macroscopic examination of sigmoid does not show necrotic signs. This way, should prevent the occurrence of perforation in megacolon at mediate postoperative, with serious results.

Aspectos embriológicos, clínicos y radiológicos de la malrotación intestinal / Embryologic, clinical, and radiological aspects of intestinal malrotation

La malrotación intestinal con su propensión al vólvulo representa un desafío diagnóstico en pacientes pediátricos. El diagnóstico precoz es de suma importancia para conseguir un buen resultado. En este artículo se revisan e ilustran los hallazgos radiológicos de la malrotación y el vólvulo de intestino medio en la infancia y adolescencia, y se discuten la embriología, la presentación clínica, el manejo radiológico y la evolución de este proceso. El diagnóstico de malrotación y vólvulo debe tenerse en cuenta siempre que se evalúe a un lactante o niño con vómitos y dolor abdominal, particularmente si los vómitos son biliosos. Un tránsito baritado generalmente dará el diagnóstico. La ecografía es muy útil, si bien no es suficientemente segura para excluir el diagnóstico. Sin embargo, el «signo del remolino» es un signo altamente sensible para el diagnóstico del vólvulo de intestino medio. El radiólogo siempre debe tener presente que esta complicación puede ocurrir a cualquier edad

Intestinal malrotation with its propensity to volvulus represents a diagnostic challenge in pediatric patients. Early diagnosis is of extreme importance for achieving a good outcome. This article reviews and illustrates the radiologic findings for malrotation and volvulus of the small bowel in childhood and adolescence. The embryology, clinical presentation, radiologic management, and evolution of this process are discussed. The diagnosis of malrotation and volvulus should be considered whenever a nursing baby or child presents with vomiting and abdominal pain, especially if the vomit is bilious. A barium follow-through usually provides the diagnosis. Ultrasound is very useful, although it cannot safely rule out the diagnosis. However, the "whirlpool sign" is a highly sensitive sign for the diagnosis of small bowel volvulus. The radiologist needs to bear in mind that this complication can occur at any age

Vólvulo de intestino delgado tras la ingesta de paquetes de hachís / Small intestine volvulus in a hashih body packer

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