Ninety percent of cases of malrotation have shown signs and symptoms of intestinal obstruction by the first year of life. It is thus an often-overlooked etiology in adult patients. Evidence-based recommendations are also limited because of the paucity of cases. This paper discusses the two cases of malrotation from diagnosis to surgical management at a tertiary academic hospital. Both are previously well adult male patients with virgin abdomen who presented with vomiting and signs of intestinal obstruction. During medical decompression, CT scan with triple contrast clinched the diagnosis of malrotation for which Ladd's procedure was done, with no operative complications. The authors' experience and previous literature support early decompression, imaging, and surgery for all cases of malrotation regardless of severity of symptoms.
bowel obstruction

Intestinal failure (IF) is the critical reduction of the gut mass or its function below the minimum needed to absorb nutrients and fluids required for adequate growth in children. Severe IF requires parenteral nutrition (PN). Pediatric IF is most commonly due to congenital or neonatal intestinal diseases or malformations divided into 3 groups: 1) reduced intestinal length and consequently reduced absorptive surface, such as in short bowel syndrome (SBS) or extensive aganglionosis; 2) abnormal development of the intestinal mucosa such as congenital diseases of enterocyte development; 3) extensive motility dysfunction such as chronic intestinal pseudo-obstruction syndromes. The leading cause of IF in childhood is the SBS. In clinical practice the degree of IF may be indirectly measured by the level of PN required for normal or catch up growth. Other indicators such as serum citrulline have not proven to be highly reliable prognostic factors in children. The last decades have allowed the development of highly sophisticated nutrient solutions consisting of optimal combinations of macronutrients and micronutrients as well as guidelines, promoting PN as a safe and efficient feeding technique. However, IF that requires long-term PN may be associated with various complications including infections, growth failure, metabolic disorders, and bone disease. IF Associated Liver Disease may be a limiting factor. However, changes in the global management of IF pediatric patients, especially since the setup of intestinal rehabilitation centres did change the prognosis thus limiting “nutritional failure” which is considered as a major indication for intestinal transplantation (ITx) or combined liver-ITx.
Bone Diseases ; Child ; Citrulline ; Enterocytes ; Humans ; Intestinal Diseases ; Intestinal Mucosa ; Intestinal Pseudo-Obstruction ; Liver Diseases ; Micronutrients ; Parenteral Nutrition ; Parenteral Nutrition, Home ; Prognosis ; Rehabilitation ; Short Bowel Syndrome

The mammalian intestine contains many different cell types but is comprised of 2 main cell types: epithelial cells and smooth muscle cells. Recent in vivo and in vitro evidence has revealed that various alterations to the DNA methylation apparatus within both of these cell types can result in a variety of cellular phenotypes including modified differentiation status, apoptosis, and uncontrolled growth. Methyl groups added to cytosines in regulatory genomic regions typically act to repress associated gene transcription. Aberrant DNA methylation patterns are often found in cells with abnormal growth/differentiation patterns, including those cells involved in burdensome intestinal pathologies including inflammatory bowel diseases and intestinal pseudo-obstructions. The altered methylation patterns being observed in various cell cultures and DNA methyltransferase knockout models indicate an influential connection between DNA methylation and gastrointestinal cells' development and their response to environmental signaling. As these modified DNA methylation levels are found in a number of pathological gastrointestinal conditions, further investigations into uncovering the causative nature, and controlled regulation, of this epigenetic modification is of great interest.
Apoptosis ; Cell Culture Techniques ; Cell Differentiation ; DNA Methylation ; DNA ; Epigenomics ; Epithelial Cells ; In Vitro Techniques ; Inflammatory Bowel Diseases ; Intestinal Mucosa ; Intestinal Pseudo-Obstruction ; Intestines ; Methylation ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Pathology ; Phenotype

In patients with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infections could aggravate the course of IBD but it is difficult to distinguish CMV infection from IBD exacerbation endoscopically. Usually, CMV tends to localize to the colon and other organic involvements were reported very rare in the IBD patients. Herein, we report a case that CMV gastric ulcer complicated with pyloric obstruction in a patient with ulcerative colitis during ganciclovir therapy, which was resolved by surgical gastrojejunostomy with review of literature.
Colitis, Ulcerative* ; Colon ; Cytomegalovirus* ; Ganciclovir ; Gastric Bypass ; Gastric Outlet Obstruction ; Humans ; Inflammatory Bowel Diseases ; Stomach Ulcer* ; Ulcer*

PURPOSE: Parenteral nutrition (PN) not only provides nutritional support but also plays a crucial role in the treatment of children with intestinal failure. The aim of this study was to evaluate the clinical significance and clinical outcomes of long-term PN. METHODS: Retrospective cohort study was conducted using the medical records of patients treated at Seoul National University Children's Hospital. This study included 19 patients who received PN for over six months. Most patients received home PN. RESULTS: The indications for PN included short bowel syndrome, chronic intestinal pseudo-obstruction, and intractable diarrhea of infancy. The median age of PN initiation was 1.3 years, and the median treatment duration was 2.9 years. Two patients were weaned from PN; 14 continued to receive PN with enteral feedings; and 3 patients died. The overall survival rates at 2 and 5 years were 93.3% and 84.0%, respectively. The incidence of catheter-related bloodstream infections was 2.7/1,000 catheter-days and was associated with younger age at PN initiation and lower initial height Z-score. Six patients developed catheter-related central vein thrombosis, with an incidence of 0.25/1,000 catheter-days. Eleven patients experienced PN-associated liver disease (PNALD), and one patient underwent multi-visceral transplant. The patients with PNALD exhibited lower final heights and body weight Z-scores. All patients experienced micronutrient deficiencies transiently while receiving PN. CONCLUSION: PN is an important and safe treatment for pediatric intestinal failure. PNALD was linked to final anthropometric poor outcomes. Micronutrient deficiencies were common. Anthropometric measurements and micronutrient levels must be monitored for successful PN completion.
Body Weight ; Catheter-Related Infections ; Child ; Cholestasis ; Cohort Studies ; Diarrhea ; Humans ; Incidence ; Intestinal Pseudo-Obstruction ; Liver Diseases ; Medical Records ; Micronutrients ; Nutritional Support ; Parenteral Nutrition ; Retrospective Studies ; Seoul ; Short Bowel Syndrome ; Survival Rate ; Thrombosis ; Veins

A variety of common and some not common gastrointestinal syndromes are thought to be based on impaired gut motility. For some, the role of motility is well defined, for others and the functional gastrointestinal disorders, in particular, the role of hypo- or dysmotility remains unclear. Over the years pharmacological and physiological laboratories have developed drugs which stimulate gut motility; many have been evaluated in motility and functional disorders with what can best be described as mixed results. Lack of receptor specificity and resultant expected and unexpected adverse events have led to the demise of some of these agents. Newer, more selective agents offer promise but the heterogeneity of the clinical disorders they target continues to pose a formidable challenge to drug development in this area.
Constipation ; Dyspepsia ; Gastrointestinal Diseases* ; Gastroparesis ; Intestinal Pseudo-Obstruction ; Irritable Bowel Syndrome ; Population Characteristics ; Sensitivity and Specificity

Hepatic portal venous gas (HPVG) is a rare radiographic finding associated with severe intra-abdominal disease and fatal outcome. Most cases of HPVG are historically related to mesenteric ischemia accompanied by bowel necrosis. The current spread of computed tomography scan promotes not only the early detection of related severe diseases but also the identification of other causes of HPVG. It has been reported in many non-fatal conditions, such as inflammatory bowel disease, intra-abdominal abscess, bowel obstruction, paralytic ileus, endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy, and gastric dilatation. Among these, paralytic ileus is a very rare condition, with no case yet reported in South Korea. Reported herein is a case of HPVG in paralytic ileus, which was treated well internally and was promptly resolved.
Abdominal Abscess ; Cholangiopancreatography, Endoscopic Retrograde ; Fatal Outcome ; Gastric Dilatation ; Ileus ; Inflammatory Bowel Diseases ; Intestinal Pseudo-Obstruction* ; Ischemia ; Korea ; Mesenteric Veins ; Necrosis ; Portal Vein ; Sphincterotomy, Endoscopic

OBJECTIVETo reveal the efficacy on early postoperative inflammatory small bowel obstruction (EPISBO) treated with electroacupuncture and acupuncture separately and make the comparison of the efficacy difference.

METHODSThrough retrospective analysis, 459 cases of EPISBO were divided into an electroacupuncture group (355 cases) and an acupuncture group (104 cases). Based on routine treatment, Zusanli (ST 36), Shangjuxu (ST 37), Taichong (LR 3), Gongsun (SP 4) and Xuanzhong (GB 39) were selected in either group, but stimulated with electroacupuncture and acupuncture separately, once per day, for 30 min each time.

RESULTSAll of 459 cases were cured. The average days of curative achievement in electroacupuncture group were less apparently than those in acupuncture group (13.5 +/- 7.5 vs. 20.8 +/- 6.5, P < 0.05). The days of curative achievement in either group were less significantly than those treated with parenteral nutrition and medication recorded in literatures (32.0 +/- 7.0, both P < 0.05).

CONCLUSIONEither electroacupuncture or acupuncture achieves a significant efficacy on EPISBO, but the efficacy of electroacupuncture is better than that of acupuncture.

Acupuncture Therapy ; Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Inflammatory Bowel Diseases ; therapy ; Intestinal Obstruction ; immunology ; therapy ; Intestine, Small ; immunology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; immunology ; therapy ; Retrospective Studies ; Young Adult

Abdominal pain is one of the most common symptoms we encounter in primary care clinics, and the patients being hospitalized for abdominal pain account for 5-6% of all the inpatients. Careful history taking and physical exams are always necessary for the diagnosis of patients having abdominal pain, because their problems may be transient and insignificant but also can be severe. For the elderly patients, common causes of abdominal pain are unspecific abdominal pain, functional disease, constipation, kidney stone, urinary tract infection, inflammatory bowel disease, biliary tract disease, acute appendicitis, diverticulitis, abdominal aortic aneurysm, peptic ulcer, intestinal obstruction, mesenteric ischemia, malignant tumor, gastroenteritis, etc. and myofacscial pain can also be the cause. We treated an elderly female patient who had suffered severe abdominal pain due to myofascial pain syndrome of the iliopsoas muscle undiagnosed for over 3 years. Therefore we report this case with review of several literatures.
Abdominal Pain ; Aged ; Aortic Aneurysm, Abdominal ; Appendicitis ; Biliary Tract Diseases ; Constipation ; Diverticulitis ; Female ; Gastroenteritis ; Humans ; Inflammatory Bowel Diseases ; Inpatients ; Intestinal Obstruction ; Ischemia ; Kidney Calculi ; Muscles ; Myofascial Pain Syndromes ; Peptic Ulcer ; Primary Health Care ; Urinary Tract Infections

PURPOSE: Intestinal atresia is a common cause of neonatal intestinal obstruction. Recently, the survival rate has been increasing from development of prenatal diagnosis, total parenteral nutrition (TPN) and neonatal intensive care. We evaluated the complication rate and cause of mortality after operative management for jejunoileal atresia. METHODS: We reviewed 62 patients (36 males, 26 females) with jejuno-ileal atresia who underwent operation from 1998 to 2007. RESULTS: There were 37 patients with jejunal atresia and 25 with ileal atresia. The average gestational age was 256+/-16.6 days and birth weight was 2,824+/-620 g. Prenatal diagnosis was performed in 45 patients (72.6%) around gestational age 27 weeks. Within 2nd day after birth, 44 patients (71%) underwent operation. Half of the jejunoileal atresia was type IIIa and type I was in 8, type II was in 3, type IIIb was in 12, and type IV was in 8. The operative treatment was resection & anastomosis in 59 patients and enterotomy & web excision in 3. They started feeding at 12.4+/-11.5 days after operation on average. The average duration of TPN was 26.7+/-23.5 days, and the incidence of cholestasis was 30.6%. Hospital days averaged 36.8+/-26 days. Early complication occurred in 14 patients (intestinal obstruction in 5, sepsis in 4, wound problem in 3, anastomosis leakage in 1, and intraabdominal abscess in 1). Late complication occurred in 7 patients (anastomosis stricture in 4 and intestinal obstruction in 3). There was only one case of mortality due to short bowel syndrome after re-operation for adhesive ileus. CONCLUSION: The operation for intestinal atresia was successful and aggressive management contributed to a low mortality rate.
Abscess ; Adhesives ; Birth Weight ; Cholestasis ; Constriction, Pathologic ; Gestational Age ; Humans ; Ileus ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Intestinal Atresia ; Intestinal Obstruction ; Male ; Parenteral Nutrition, Total ; Parturition ; Prenatal Diagnosis ; Sepsis ; Short Bowel Syndrome ; Survival Rate