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Morera-Grau A, Membrilla-Fernández E, González-Castillo AM, Pelegrina-Manzano A, Guerrero-Ortiz MA, Téllez-Marquès C, Pons-Fraguero MJ, Guzmán-Ahumada J, Pera-Román M, Sancho-Insenser JJ. Caecal volvulus and jejunostomy: challenging diagnostic. J Surg Case Rep 2021; 2021:rjab148. [PMID: 33927877 PMCID: PMC8068471 DOI: 10.1093/jscr/rjab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
Caecal volvulus represent the 20–40% of colonic volvulus, being the second most frequent localization. It causes intestinal occlusion symptomatology (nausea, vomiting, abdominal distension). We present a case of 45-year-old women with feeding jejunostomy tube due to connatal anoxia. She arrives at A&E after 12 h of vomits and abdominal pain. The CT scan shows a small intestine dilation that suggested a small intestine volvulus. A laparotomy is performed showing a caecal volvulus, so ileo-cequectomy with primary anastomosis is performed. After several complications, she was discharged after 60 days of hospital stay. Caecal volvulus can be challenging to diagnose by clinic, because it can be hardly differenced from other intestinal occlusion causes. CT scan can be useful to reach the diagnostic and see signs of tissue suffering. In contrast with sigma volvulus, endoscopic treatment has not shown any benefit to solve it.
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Affiliation(s)
- A Morera-Grau
- General Surgery Department, Hospital del Mar, Barcelona, Spain
| | - E Membrilla-Fernández
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - A M González-Castillo
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | | | | | - J Guzmán-Ahumada
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - M Pera-Román
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
| | - J J Sancho-Insenser
- General Surgery Department, Hospital del Mar, Barcelona, Spain.,Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
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Bravo-Salva A, González-Castillo AM, Vela-Polanco FF, Membrilla-Fernández E, Vila-Domenech J, Pera-Román M, Sancho-Insenser JJ, Pereira-Rodríguez JA. Incidence of Incisional Hernia After Emergency Subcostal Unilateral Laparotomy: Does Augmentation Prophylaxis Play a Role? World J Surg 2019; 44:741-748. [PMID: 31741074 DOI: 10.1007/s00268-019-05282-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few data are available about the frequency of incisional hernia in an emergency subcostal laparotomy. Our objective is to analyze the incidence of incisional hernia after emergency subcostal laparotomy and evaluate if prophylactic mesh could help prevent it. METHODS This study is a monocentric retrospective analysis following STROBE guideline statements of all patients who underwent an emergency subcostal laparotomy between January 2011 and July 2017 in our University Hospital. We compared complications and incidence of incisional hernia between patients who received sutures (Group S; N = 203) and patients with prophylactic onlay mesh (Group M; N = 80). A multivariate risk factor analysis of incisional hernia was performed. An incisional hernia-estimated risk calculator equation was created. RESULTS A total of 283 patients were analyzed. There were 80 patients in Group M and 203 in Group S. In short-term outcomes, length of surgery (213 ± 115 min vs 165 ± 73.3 min, P = 0.001) and hospital stay (16.4 ± 18.7 vs 11.6 days ± 13.4, P = 0.038) were longer in Group M. Long-term follow-up was conducted in 207 patients with a mean follow-up time of 39.3 ± 23 months. Incisional hernia was detected in 29 (19.1%) patients in Group S but in only two (3.8%) patients in Group M (P = 0.008). In the multivariate analysis, a risk factor analysis included wound infection (4.91 HR (2.12-11.4); P < 0.001), previous hernia repair (2.86 HR (1.24-6.61); P = 0.014), and shock (2.64 HR (1.01-6.93); P = 0.048). CONCLUSIONS The incidence of incisional hernia after emergency subcostal laparotomy is high. Risk factors are wound infection, shock, and previous hernia surgery. The use of prophylactic mesh augmentation was safe and reduced the incidence of incisional hernia.
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Affiliation(s)
- A Bravo-Salva
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain. .,Departament de Ciències, Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.
| | - A M González-Castillo
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - F F Vela-Polanco
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - E Membrilla-Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Departament de Cirurgia, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - J Vila-Domenech
- IMIM-Institut de Recerca Hospital del Mar, Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - M Pera-Román
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Departament de Cirurgia, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - J J Sancho-Insenser
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Departament de Cirurgia, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain
| | - J A Pereira-Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Departament de Ciències, Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
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