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Thomson SR, Hanna SM, Sarkar A, Das A, Perera DS. Adult intestinal malrotation presenting as caecal volvulus with incidental findings of duplicate inferior vena cava and other rare abnormalities: case report. J Surg Case Rep 2024; 2024:rjae132. [PMID: 38463733 PMCID: PMC10924739 DOI: 10.1093/jscr/rjae132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/12/2024] Open
Abstract
Intestinal malrotation and duplication of the inferior vena cava are rarely diagnosed in adult patients; however, incidence is likely underestimated as they are usually asymptomatic. These congenital malformations have been previously reported in the same patient twice but never with colonic obstruction or ischaemia. A 25-year-old female presented with nausea, vomiting, obstipation, and abdominal pain, and on computed tomography of the abdomen and pelvis was diagnosed with a caecal volvulus and pneumatosis coli associated with intestinal malrotation requiring emergency right hemicolectomy. Incidentally, the patient was noted to have duplication of the inferior vena cava, azygos continuation of the inferior vena cava, and splenic fragmentation. This constellation of symptoms has not been reported in the literature previously. The pattern of malformations follows that of polysplenia syndrome. Although rare, awareness of these malformations can be useful to clinicians.
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Affiliation(s)
- Samuel R Thomson
- Department of Surgery, St George Hospital, Gray St, Kogarah, Sydney, NSW 2217, Australia
| | - Sam M Hanna
- Department of Surgery, St George Hospital, Gray St, Kogarah, Sydney, NSW 2217, Australia
| | - Amit Sarkar
- Department of Surgery, St George Hospital, Gray St, Kogarah, Sydney, NSW 2217, Australia
| | - Atandrila Das
- Department of Surgery, St George Hospital, Gray St, Kogarah, Sydney, NSW 2217, Australia
| | - Dayashan S Perera
- Department of Surgery, St George Hospital, Gray St, Kogarah, Sydney, NSW 2217, Australia
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2
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Saab K, Brahmandam AS, Brackett AL, Desai MM, Dardik A, Guzman RJ, Chaar CIO. Systematic review of inferior vena cava atresia. J Vasc Surg Venous Lymphat Disord 2023; 11:1253-1264. [PMID: 37453547 DOI: 10.1016/j.jvsv.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Inferior vena cava (IVC) atresia is a rare venous anomaly characterized by absence of the IVC. It has been associated with deep vein thrombosis (DVT) and other congenital anomalies. The aim of the present study is to provide a comprehensive summary of the literature on IVC atresia and discuss the presentation and outcomes of patients with IVC atresia. METHODS A systematic review of the English literature up to April 2020 was performed. The presentations and treatments reported were noted and compared between the two sexes. The IVC atresia cases were further stratified into isolated IVC atresia and IVC atresia associated with other congenital anomalies. RESULTS A total of 412 abstracts were screened, with 178 reports included. A total of 376 patients were analyzed. Overall, males seem to be more affected than females, with a ratio of almost 2:1 (male, 227 [64.1%]; vs female, 127 [35.8%]). However, females were more likely to have congenital IVC atresia compared with males (46.1% vs 21.3%; P < .001). The mean age at presentation was 27.9 ± 18.0 years (range, 0-77 years), with no differences between the sexes. Most patients with IVC atresia presented with DVT (n = 242 of 376; 64.3%), with the iliac veins most often affected (n = 159 of 242; 65.7%). No difference was found in the reported proportion of patients presenting with DVT between the two sexes. The symptom presentation was similar, with leg pain and swelling the most common in both sexes. The patients were treated either medically with anticoagulation or surgically (open or endovascular). No mortality was reported with isolated IVC atresia in either treatment group. However, the mortality of patients with IVC atresia associated with other congenital anomalies was 11.7%. CONCLUSIONS IVC atresia is more common in males but seems to have a predilection for females in the setting of other congenital anomalies. Most patients present with leg pain and swelling related to the development of DVT. Open and endovascular surgical interventions to treat IVC atresia have been reported in 18.3% of patients reviewed, with acceptable mid-term results in terms of patency and symptomatic relief.
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Affiliation(s)
- Karim Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Anand S Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Alexandria L Brackett
- Clinical Research and Education, Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, CT
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT.
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Montero-Macías R, Krief D, Villefranque V, Kilani M, Castillo-Tuñon JM. Anatomy, embryology, and imaging of situs ambiguous with polysplenia and left IVC. Radiol Case Rep 2023; 18:1727-1732. [PMID: 36895889 PMCID: PMC9989316 DOI: 10.1016/j.radcr.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 03/02/2023] Open
Abstract
The situs ambiguous or heterotaxy syndrome is a type of syndrome that involves multiple visceral abnormalities, vascular ones and associated with left isomerism. Malformation of gastroenterologic system includes polysplenia (segmented spleen or multiple splenules), agenesis (partial or complete) of the dorsal pancreas and anomalous of the inferior vena cava implantation. Here, we describe and show the anatomy of a patient with left side inferior vena cava, situs ambiguous (complete common mesentery), polysplenia, and short pancreas. We also discuss about the embryologic process and the implications of these anomalies during gynecologic, digestive, and liver surgeries.
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Affiliation(s)
- Rosa Montero-Macías
- Obstetrics and Gynecology Department, Centre Hospitalier Simone-Veil, 14 Rue de Saint-Prix, 95600 Eaubonne, France
| | - David Krief
- Obstetrics and Gynecology Department, Centre Hospitalier Simone-Veil, 14 Rue de Saint-Prix, 95600 Eaubonne, France
| | - Vincent Villefranque
- Obstetrics and Gynecology Department, Centre Hospitalier Simone-Veil, 14 Rue de Saint-Prix, 95600 Eaubonne, France
| | - Mohamed Kilani
- Radiology Department, Centre Hospitalier Simone-Veil, Eaubonne, France
| | - Juan Manuel Castillo-Tuñon
- Hepatic, General and Digestive Surgery Department, Virgen del Macarena University Hospital, Seville, Spain
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Harrabi F, Jabeur M, Houssem A, Abdelkader M, Mehdi BL, Mohamed Amine S, Mohamed BM, Ali BA. Co-Existence of An Unusual Branching Pattern of Celiacomesenteric Trunk With Complete Common Mesentery in a 48-Year-Old Man: A Case Report. Am J Mens Health 2022; 16:15579883221139369. [PMID: 36484302 PMCID: PMC9742926 DOI: 10.1177/15579883221139369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Celiacomesenteric trunk (CMT) refers to the common origin of celiac trunk and superior mesenteric artery which is a very rare anatomical variation. CMT is incidentally diagnosed during angiography or abdominal computed tomography scanning. The diagnosis of CMT may inform surgical practice and prevent damage during invasive radiologic procedures, lowering thus the rate of iatrogenic errors. Complete common mesentery is in its turn a rarer congenital anomaly that arises from an abnormal rotation of primitive small intestine during embryonic development. We report a case of a 48-year-old man, suffering from chronic abdominal pain, and postprandial discomfort. The patient underwent an abdominal contrast-enhanced computed tomography that detected a CMT associated with common complete mesentery. According to our review of bibliography, this is the first case report to simultaneously report both congenital anomalies (CMT and common complete mesentery). Furthermore, the CMT described here has not been described in previous classifications and represent a novel anatomical variation of CMT.
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Affiliation(s)
- Fathia Harrabi
- Department of General Surgery, Sahloul
University Hospital, Sousse, Tunisia,Fathia Harrabi, Department of General
Surgery, Sahloul University Hospital, Sousse, 4002, Tunisia.
| | - Methnani Jabeur
- LR12SP11, Biochemistry Department,
Sahloul University Hospital, Sousse, Tunisia,LR19ES09, Laboratoire de Physiologie de
l’Exercice et Physiopathologie: de l’Intégré au Moléculaire Biologie, Médecine et
Santé, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Ammar Houssem
- Department of General Surgery, Sahloul
University Hospital, Sousse, Tunisia
| | - Mizouni Abdelkader
- Department of General Surgery, Sahloul
University Hospital, Sousse, Tunisia
| | - Ben Latifa Mehdi
- Department of General Surgery, Sahloul
University Hospital, Sousse, Tunisia
| | | | | | - Ben Ali Ali
- Department of General Surgery, Sahloul
University Hospital, Sousse, Tunisia
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Sadiq AM, Sadiq AM. Heterotaxy Syndrome with Polysplenia, Fused Adrenal Glands, and Diabetes Mellitus. Clin Med Insights Cardiol 2022; 16:11795468221116851. [PMID: 36187466 PMCID: PMC9520153 DOI: 10.1177/11795468221116851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
Heterotaxy syndrome is a rare congenital heart disease with a disarrangement of the heart and abdominal organs. We present a young African female with features of heart failure, diffuse irregular cardiac murmurs, and palpable, tender epigastric mass. A chest and abdominal computed tomography (CT) identified heterotaxy syndrome with left isomerism and fused adrenal glands. This case highlights the feature of fused adrenal glands in a patient with polysplenia.
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Affiliation(s)
- Abid M Sadiq
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Abid M Sadiq, Department of Internal Medicine, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania.
| | - Adnan M Sadiq
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Radiology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Draghmeh M, Taher A, Atatri Y, Al-rub FA, Muhaisen W, Khanfar O. Wandering spleen torsion in a patient with polysplenia syndrome. Radiol Case Rep 2022; 17:2373-2377. [PMID: 35570876 PMCID: PMC9096468 DOI: 10.1016/j.radcr.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
Polysplenia Syndrome is a rare condition that refers to the presence of 2 or more spleens in association with other thoracoabdominal abnormalities. Here, we report a case of a 13-year-old girl who presented with acute lower abdominal pain and was diagnosed with polysplenia syndrome after obtaining a CT scan of her chest, abdomen and pelvis. Diagnostic imaging also revealed the presence of a wandering spleen hanging in the lower abdomen and upper pelvic cavity and showing signs of infarction. The patient underwent splenectomy afterward and splenic torsion was confirmed intraoperatively. To the best of our knowledge, this was the first reported case of wandering spleen torsion in a patient with polysplenia syndrome. Physicians should keep in mind the possibility of a wandering spleen torsion presenting in various locations when dealing with polysplenia syndrome patients complaining of abdominal pain.
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A Rare Case of Polysplenia Syndrome Associated with Severe Cardiac Malformations and Congenital Alveolar Dysplasia in a One-Month-Old Infant: A Complete Macroscopic and Histopathologic Study. J Cardiovasc Dev Dis 2022; 9:jcdd9050135. [PMID: 35621846 PMCID: PMC9144318 DOI: 10.3390/jcdd9050135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/05/2023] Open
Abstract
Polysplenia syndrome represents a type of left atrial isomerism characterized by multiple small spleens, often associated with cardiac malformations and with situs ambiguus of the abdominal organs. The case presented is of a one-month-old male infant, weighing approximately 3000 g, born at the County Clinical Emergency Hospital of Sibiu, who was hospitalized from birth until death. The patient suffered cardio-respiratory arrest due to severe hypoxia and septicemia on the background of a series of complex cardiac malformations associated with congenital abdominal organ anomalies. Examination of the body revealed a common atrium with complete atrioventricular canal defect, left ventricular hypertrophy, right ventricle hypoplasia, truncus arteriosus, superior vena cava duplication, bilobation of the lungs, situs ambiguous of the abdominal organs with right-sided stomach, a midline liver, gall bladder agenesis, multiple right-sided spleens and complete inversion of the intestines and pancreas. Histopathology concluded that the patient suffered cardiac lesions consistent with infantile lactic acidosis, as well as pulmonary modifications suggesting congenital alveolar dysplasia and altered hepatic architecture compatible with fibrosis.
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Multimodality imaging of developmental splenic anomalies: tips and pitfalls. Clin Radiol 2022; 77:319-325. [PMID: 35000764 DOI: 10.1016/j.crad.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
Anomalies in number and location may occur during splenic development. This review aims to offer a brief overview of splenic function and embryology and a detailed account of the imaging appearances using different imaging techniques of the normal spleen and various congenital splenic anomalies including (1) abnormal viscero-atrial situs, (2) splenogonadal fusion, (3) intrapancreatic accessory spleen, (4) wandering spleen, and (5) splenosis. Emphasis is placed on the salient features that help radiologists recognise important associations (e.g., asplenia/polysplenia in situs abnormalities), avoid diagnostic pitfalls (e.g., mistaking intrapancreatic accessory spleen as pancreatic neoplasms), and potential complications (e.g., acute torsion in wandering spleen). The correct identification of the said anomalies from more sinister causes, such as malignancies, are essential, where early intervention is necessary.
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9
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Shahrouki P, Lee EW, Ruehm S. Polysplenia syndrome and sickle cell trait: extensive deep venous thrombosis from venous stasis and hypercoagulability. Clin Imaging 2021; 82:127-131. [PMID: 34813990 DOI: 10.1016/j.clinimag.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Deep venous thrombosis is a hitherto under-recognized complication occurring in patients with polysplenia syndrome, despite the high prevalence of venous anomalies such as interrupted inferior vena cava (IVC) with azygos/hemiazygos continuation. Here we report the first case of concurrent polysplenia (as evidenced by interrupted IVC with azygos/hemiazygos continuation, multiple left-sided spleens, bowel malrotation with inverted mesenteric veins, preduodenal portal vein, and pancreatic hypoplasia/partial agenesis of the dorsal pancreas) and sickle cell trait, complicated by extensive deep venous thrombosis refractory to medical and interventional radiologic management.
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Affiliation(s)
- Puja Shahrouki
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Stefan Ruehm
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
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Esmat HA, Naseri MW, Shirzai A. Heterotaxy polysplenia syndrome in an adult female with complete endocardial cushion defect. Radiol Case Rep 2021; 16:1080-1084. [PMID: 33717387 PMCID: PMC7921178 DOI: 10.1016/j.radcr.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/30/2021] [Accepted: 02/06/2021] [Indexed: 12/01/2022] Open
Abstract
Heterotaxy syndrome is a rare condition characterized by the abnormal arrangement of thoracoabdominal organs across the left-right axis of the body. It is generally classified as right and left atrial isomerism or asplenia and polysplenia syndrome, even though there are overlaps and uncertainties. The diagnosis of isomerism is typically made by echocardiography. However, multidetector computed tomography and MRI can help in obtaining detailed data on the morphology of the heart, great vessels, the anatomy of the internal organs, and their mutual arrangement that make an accurate diagnosis of heterotaxy syndrome. The authors present here the imaging findings of the heterotaxy polysplenia syndrome in a 21-year-old female with a complete endocardia cushion defect and a duplicated right renal vein.
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Affiliation(s)
- Habib Ahmad Esmat
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Mohammad Wali Naseri
- Department of Internal Medicine, Division of Endocrinology, Metabolism, and Diabetes, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Asadullah Shirzai
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
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Ferrer-Márquez M, Rubio-Gil F, Solvas-Salmerón MJ, Torrente-Sánchez MJ, Martínez-Amo-Gámez A, Solbes-Vila R, Ferrer-Ayza M. One Anastomosis Gastric Bypass in Patient with Situs Ambiguous. Obes Surg 2021; 31:2346-2347. [PMID: 33625654 DOI: 10.1007/s11695-021-05265-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Manuel Ferrer-Márquez
- Department of Bariatric Surgery (Obesidad Almería), General Surgery, Hospital Mediterráneo, Almería, Spain.
| | - Francisco Rubio-Gil
- Department of Bariatric Surgery (Obesidad Almería), General Surgery, Hospital Mediterráneo, Almería, Spain
| | | | | | | | | | - Manuel Ferrer-Ayza
- Department of Bariatric Surgery (Obesidad Almería), General Surgery, Hospital Mediterráneo, Almería, Spain
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