Reversed midgut rotation revealed by cecal volvulus in the elderly: A case report.

INTRODUCTION: Reverse midgut rotation constituted an extremely rare intestinal malrotation. Its recognition in the elderly was challenging as in our case revealed by cecal volvulus. CASE PRESENTATION: A 78-years old man consulted for diffuse abdominal, vomiting, bowel movement and passing gas inability. Computed tomography concluded to cecal and last ileum loop volvulus with small intestine dilation upstream. Emergent laparotomy confirmed the existence of a cecal volvulus associated to a reversed midgut rotation non diagnosed at computed tomography before surgery. A Ladd' procedure was carried out. An isoperistaltic side-by-side ileocolic manual anastomosis was performed. DISCUSSION: Our case illustrated an extremely rare reversed midgut rotation in the elderly accounting for 2 to 7 % of all embryologic midgut malrotation anomalies. It could be revealed by mobile right colon volvulus as in our case, whole midgut volvulus, retro-arterial tunnel pressure transverse colon stenosis, or Ladd' bands duodenojejunal obstruction. Its recognition at the elderly was challenging and needed careful computed tomography combined signs determination. Surgical treatment accounted for the treatment of choice for reversed midgut rotation especially in emergency settings as in our case. Ladd' procedure is still the most performed procedure. CONCLUSIONS: Reverse midgut rotation constituted an extremely rare congenital intestinal malrotation. Its diagnosis in the elderly was challenging implicating careful interpretation of computed tomography.

Arteriovenous gastric malformation: A challenging diagnosis. A case report.

INTRODUCTION: Gastro-intestinal bleeding etiological diagnosis could be challenging especially for rare etiologies as it was the case of our patient having an arteriovenous gastric malformation. CASE PRESENTATION: A 50-years old man consulted for hematemesis. Esophagogastroduodenoscopy didn't show bleeding signs. Angio-scan revealed an arteriovenous gastric malformation. Median laparotomy revealed multiple radiologically unsuspected great omentum arteriovenous malformations and confirmed the existence of this arteriovenous malformation in the posterior part of the lesser curvature guided by per-operative esophagogastroduodenoscopy. Atypical gastrectomy was performed. DISCUSSION: Our case illustrated a rare life-threatening condition with a challenging diagnosis. Arteriovenous gastric malformation accounted for 1 to 2 % of nonvariceal upper gastrointestinal bleeding. Great omentum localization corresponded to an exceptional condition that had been reported in only one adult patient and one childhood case. Its pathogenesis is still unknown. CONCLUSIONS: Arteriovenous gastric malformation had to be considered in case of normal endoscopic esophagogastroduodenoscopy. Computed tomography had to be done for both diagnosis and therapeutic purposes.

[Endoscopic removal of intrauterine device perforating the sigmoid colon: case report]. / Retrait endoscopique d'un dispositif intra-utérin perforant le côlon sigmoïde: à propos d'un cas.

Intrauterine device (IUD) is the mainstay of family planning methods in developing countries. However, it is associated with severe complications such as bleeding, perforation and migration to adjacent organs. Although perforation of the uterus is not rare, migration to the sigmoid colon is exceptional. We here report a case of IUD migration into sigmoid colon; this was removed via low endoscopy. The study involved a 45-year-old woman using an IUD who presented with pelvic pain associated with a feeling of pelvic heaviness 6 years later of insertion. Clinical examination was without abnormalities, and computed tomography (CT) scan showed the IUD embedded in the sigmoid colon wall. Diagnostic and therapeutic laparoscopy was performed, which objectified IUD-related intestinal perforation. IUD was partially embedded in the sigmoid colon wall and couldn't be removed. The device was removed during colonoscopy by diathermy loop excision (15 mm in diameter).

Value of Cine-MRI sequences before and after injection in the diagnosis of acute myocarditis.

BACKGROUND: Cardiovascular magnetic resonance (CMR) has become the examination of choice in case of suspicion of acute myocarditis. Late gadolinium enhancement (LGE) imaging is very important to establish this diagnosis. Cine MRI sequences are useful for the study of the myocardial contractility. AIMS:   The purpose is to estimate the value of cine MRI sequences before and after injection for the diagnosis of acute myocarditis compared with late gadolinium enhanced sequences. METHODS: We prospectively included 40 patients having a high suspicion of acute myocarditis and examined using a 1.5 Tesla CMR. Cine MRI sequences before and after injection were performed. The protocol also include  T2-weighted  short- tau-inversion-recovery (STIR T2) fast spin echo MRI and LGE imaging eight minutes after injection with visual adjustment of inversion time. RESULTS: Delayed enhancement was found among 23 patients. Fifteen patients (65 %) presented a spontaneous hyper signal detected visually on Cine MRI sequences before injection and 11 patients (48 %) on STIR T2. The hyper signal on Cine MRI sequences after injection of gadolinium was the same topography that the late raising at 23 patients. In addition, we highlighted a significant difference between this hyper signal before injection and the left ventricle ejection fraction (p=0.022) as well as with the telesystolic volume of the left ventricle (LV) indexed by the body mass (p=0.039). CONCLUSION: Our study suggests that Cine MRI sequences after injection are of equal performance in the diagnosis of acute myocarditis as the LGE sequences and its contibution is important when we want to shorten the examination or when inversion time isn't optimal.