DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20212493

Sustaining viability in a pre-gangrenous bowel with midgut volvulus

Fatima Al Zahra, Nadeem Akhtar, Sana Khan, Mohammed Abdulmomen Abdullah Saif, Muhammad Umair Butt, Ramsha Syed

Abstract


Midgut volvulus is a condition peculiar to neonates having acute abdomen. The condition is anticipated in any neonate having bilious vomitus and inability to pass stools. This being a surgical emergency does not sanction any time-consuming radiological procedures, thus, history and the clinical picture are sufficient to warrant surgical exploration. A sick neonate in the 2nd week of life presented with all signs and symptoms of midgut volvulus for which he was explored. Exploration gave the outlook of a necrotic midgut along its entire length. No haste was made in resection as it had a fatal prognosis for survival, instead, watchful waiting opted after necessary measures were taken to allow for the resumption of perfusion. Not only the baby survived to undergo a relook laparotomy showing marked improvement but also showed improvement in lab values and started passing stool and tolerating orally after a wait of three weeks post 1st laparotomy. Midgut volvulus leading to seemingly necrotic intestine should be given due consideration by relook surgery. The alternative would be total resection followed by short bowel syndrome, need for an intestinal transplant while being on TPN. This approach gives an immense advantage by giving the gut a fair chance to restore its perfusion by gut rest after de-twisting.  


Keywords


Volvulus, Ischemia, Obstruction

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References


Lin JN, Lou CC, Wang KL. Intestinal malrotation and midgut volvulus: a 15-year review. J Formos Med Assoc. 1995;94(4):178-81.

Shah MR, Levin TL, Blumer SL, Berdon WE, Jan DM, Yousefzadeh DK. Volvulus of the entire small bowel with normal bowel fixation simulating malrotation and midgut volvulus. Pediatr Radiol. 2015;45(13):1953-6.

Meng X, Liu L, Jiang H. Indications and procedures for second-look surgery in acute mesenteric ischemia. Surg Today. 2010;40(8):700-5.

Kaminsky O, Yampolski I, Aranovich D, Gnessin E, Greif F. Does a second-look operation improve survival in patients with peritonitis due to acute mesenteric ischemia? A five-year retrospective experience. World J Surg. 2005;29(5):645-8.

Amano H, Uchida H, Kawashima H, Tanaka Y, Kishimoto H. Full-thickness small intestine necrosis with midgut volvulus, distributed in a patchy fashion, is reversible with moderate blood flow: resumption of normal function to non-viable intestine. Nagoya J Med Sci. 2014;76(3):375-80.

Amano H, Uchida H, Kawashima H, Tanaka Y, Kishimoto H. Full-thickness small intestine necrosis with midgut volvulus, distributed in a patchy fashion, is reversible with moderate blood flow: resumption of normal function to non-viable intestine. Nagoya J Med Sci. 2014;76(3):375-80.

Jan IA, Ziaullah M, Obaid LO, Hassan MA, Shehhi MA. Planned Second look laparotomy in neonatal volvulus - A safe approach for bowel salvage. Pak J Med Sci. 2018;34(2):508-10.

Eckstein HH. Acute mesenteric ischemia. Resection or reconstruction?. Chirurg. 2003;74(5):419-31.

Brencher L, Petrat F, Stych K, Hamburger T, Kirsch M. Effect of Glycine, Pyruvate, and Resveratrol on the Regeneration Process of Postischemic Intestinal Mucosa. Biomed Res Int. 2017;1072969.

Erikoglu M, Kaynak A, Beyatli EA, Toy H. Intraoperative determination of intestinal viability: a comparison with transserosal pulse oximetry and histopathological examination. J Surg Res. 2005;128(1):66-9.