latin volvere 'to roll'

WordNet

abnormal twisting of the intestines (usually in the area of the ileum or sigmoid colon) resulting in intestinal obstruction
any of numerous plants of the genus Convolvulus
genus of mostly climbing or scrambling herbs and shrubs: bindweed

PrepTutorEJDIC

サンシキヒルガオ(アサガオの一種)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/10/04 10:06:35」(JST)

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[Wiki en表示]

A volvulus is a bowel obstruction^[1] with a loop of bowel whose nose has abnormally twisted on itself.^[2]

Types

volvulus neonatorum
volvulus of the small intestine
volvulus of the caecum (cecum), also cecal volvulus
sigmoid colon volvulus (sigmoid volvulus)
volvulus of the transverse colon
volvulus of the splenic flexure, the rarest
gastric volvulus
ileosigmoid knotting

Signs and symptoms

Regardless of cause, volvulus causes symptoms by two mechanisms:^{[citation needed]}

One is bowel obstruction, manifested as abdominal distension and vomiting.
The other is ischemia (loss of blood flow) to the affected portion of intestine. Depending on the location of the volvulus, symptoms may vary. For example, in patients with a cecal volvulus, the predominant symptoms may be those of a small bowel obstruction (nausea, vomiting and lack of stool or flatus), because the obstructing point is close to the ileocecal valve and small intestine. In patients with a sigmoid volvulus, although abdominal pain may be present, symptoms of constipation may be more prominent.

Volvulus causes severe pain and progressive injury to the intestinal wall, with accumulation of gas and fluid in the portion of the bowel obstructed.^[2] Ultimately, this can result in necrosis of the affected intestinal wall, acidosis, and death. This is known as a closed loop obstruction because there exists an isolated ("closed") loop of bowel. Acute volvulus often requires immediate surgical intervention to untwist the affected segment of bowel and possibly resect any unsalvageable portion.^[2]

Volvulus occurs most frequently in middle-aged and elderly men.^[2] Volvulus can also arise as a rare complication in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops.^[3]

Sigmoid volvulus is the most-common form of volvulus of the gastrointestinal tract^[4] and is responsible for 8% of all intestinal obstructions.^{[citation needed]} Sigmoid volvulus is particularly common in elderly persons and constipated patients. Patients experience abdominal pain, distension, and absolute constipation.

Cecal volvulus is slightly less common than sigmoid volvulus and is associated with symptoms of abdominal pain and small bowel obstruction.

Volvulus can also occur in patients with Duchenne muscular dystrophy due to the smooth muscle dysfunction.^{[citation needed]}

Causes

Midgut volvulus occurs in patients (usually in infants) that are predisposed because of congenital intestinal malrotation. Segmental volvulus occurs in patients of any age, usually with a predisposition because of abnormal intestinal contents (e.g. meconium ileus) or adhesions. Volvulus of the cecum, transverse colon, or sigmoid colon occurs, usually in adults, with only minor predisposing factors such as redundant (excess, inadequately supported) intestinal tissue and constipation.

Peaks in the incidence of ileosigmoid knotting in Islamic countries during Ramadan lead to the idea that the eating of a large bulky meal only once per day contributes to this type of volvulus, which is uncommon in the West.

Diagnosis and Differential Diagnosis

After taking a thorough history, the diagnosis of colonic volvulus is usually easily included in the differential diagnosis. Abdominal plain x-rays are commonly confirmatory for a volvulus, especially if a "bent inner tube" sign or a "coffee bean" sign are seen. These refer to the shape of the air filled closed loop of colon which forms the volvulus. Should the diagnosis be in doubt, a barium enema may be used to demonstrate a "bird's beak" at the point where the segment of proximal bowel and distal bowel rotate to form the volvulus. This area shows an acute and sharp tapering and looks like a bird's beak. If a perforation is suspected, barium should not be used due to its potentially lethal effects when distributed throughout the free infraperitoneal cavity. Gastrografin, which is safer, can be substituted for barium.

The differential diagnosis includes the much more common constricting or obstructing carcinoma. In approximately 80 percent of colonic obstructions, an invasive carcinoma is found to be the cause of the obstruction. This is usually easily diagnosed with endoscopic biopsies.

Diverticulitis is a common condition with different presentations. Although diverticulitis may be the source of a colonic obstruction, it more commonly causes an ileus, which appears to be a colonic obstruction. ^[5] Endoscopic means can be used to secure a diagnosis although this may cause a perforation of the inflamed diverticular area. CT scanning is the more common method to diagnose diverticulitis. The scan will show mesenteric stranding in the involved segment of edematous colon which is usually in the sigmoid region. Micro perforations with free air may be seen.

Ulcerative colitis or Crohn's disease may cause colonic obstruction. The obstruction may be acute or chronic after years of uncontrolled disease leads to the formation of strictures and fistulas . The medical history is helpful in that most cases of inflammatory bowel disease are well known to both patient and doctor.

Other rare syndromes, including Ogilvie's syndrome, chronic constipation and impaction may cause a pseudo obstruction. ^[6]

An x-ray of a person with a small bowel volvulus.

Abdominal X-Ray
Upper GI series

Treatment

Perform sigmoidoscopy for suspected sigmoid volvulus. If the mucosa of the sigmoid looks normal and pink, place a rectal tube for decompression, repair any fluid, electrolyte, cardiac, renal or pulmonary evaluation and repair, and then take the patient to the operating room for repair. If surgery is not performed, there is a high rate of recurrence.

For patients with signs of sepsis or an abdominal catastrophe, immediate surgery and resection is advised.

Laparotomy for other forms of volvulus, especially cecal volvulus.

References

^ "volvulus" at Dorland's Medical Dictionary
^ ^a ^b ^c ^d Wedding, Mary Ellen; Gylys, Barbara A. (2004). Medical Terminology Systems: A Body Systems Approach (Medical Terminology (W/CD & CD-ROM) (Davis)). Philadelphia, Pa: F. A. Davis Company. ISBN 0-8036-1249-4.
^ Mayo Clinic Staff (2006-10-13). "Redundant colon: A health concern?". Ask a Digestive System Specialist. MayoClinic.com. Archived from the original on 2007-09-29. http://web.archive.org/web/20070929110621/http://www.mayoclinic.com/health/redundant-colon/AN00239/rss=1. Retrieved 2007-06-11.
^ Turan M, Sen M, Karadayi K, et al. (January 2004). "Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process". Rev Esp Enferm Dig 96 (1): 32–5. PMID 14971995. http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=456022&TO=RVN&Eng=1.
^ Hoffman, Gary H. (2007-08-16). "Diverticulosis/Diverticulitis - For Physicians". Time To Call The Surgeon?. Los Angeles Colon and Rectal Surgical Associates. LAcolon.com. http://www.lacolon.com/patient-education/diverticulosis-and-diverticulitis. Retrieved 20012-07-07.
^ Hoffman, Gary H. (2009-10-27). "What is Constipation?". What Can Be Done About Constipation. Los Angeles Colon and Rectal Surgical Associates. LAcolon.com. http://www.lacolon.com/conditions/constipation. Retrieved 20012-07-06.

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UpToDate Contents

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1. S状結腸軸捻転 sigmoid volvulus
2. 腸回転異常 intestinal malrotation
3. 盲腸軸捻転症 cecal volvulus
4. 成人における胃捻転 gastric volvulus in adults
5. 小児および思春期における急性腹症の原因 causes of acute abdominal pain in children and adolescents

English Journal

Gastric volvulus following diagnostic upper gastrointestinal endoscopy: a rare complication.

Karthikeyan VS, Sistla SC, Ram D, Rajkumar N.Author information Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.AbstractEsophagogastroduodenoscopy (EGD) is a commonly used, safe diagnostic modality for evaluation of epigastric pain and rarely its major complications include perforation, haemorrhage, dysrhythmias and death. Gastric volvulus has been reported to complicate percutaneous endoscopic gastrostomy but its occurrence after diagnostic EGD has not yet been reported in literature. The successful management relies on prompt diagnosis and gastric untwisting, decompression and gastropexy or gastrectomy in full thickness necrosis of the stomach wall. A 38-year-old woman presented with epigastric pain and EGD showed pangastritis. Immediately after EGD she developed increased severity of pain, vomiting and abdominal distension. Emergency laparotomy carried out for peritoneal signs revealed eventration of left hemidiaphragm with the stomach twisted anticlockwise in the longitudinal axis. After gastric decompression and untwisting of volvulus, anterior gastropexy and gastrostomy was carried out. Hence, we report this rare complication of diagnostic endoscopy and review the existing literature on the management.
BMJ case reports.BMJ Case Rep.2014 Feb 10;2014. pii: bcr2013202833. doi: 10.1136/bcr-2013-202833.
Esophagogastroduodenoscopy (EGD) is a commonly used, safe diagnostic modality for evaluation of epigastric pain and rarely its major complications include perforation, haemorrhage, dysrhythmias and death. Gastric volvulus has been reported to complicate percutaneous endoscopic gastrostomy but its oc
PMID 24515235

Gastric Dilitation-Volvulus in a Red Panda (Ailurus fulgens).

Schlanser JR, Agnew D, Paperd DW, Harrison TM.Author information Potter Park Zoo.AbstractA 10 year-old male red panda presented acutely with symptoms of shock due to acute abdominal distress and respiratory compromise. Abdominal ultrasound confirmed a severely distended stomach for which passage of an orogastric tube for relief was unsuccessful. Intra-operatively, the stomach was found to be distended and torsed around its long axis supporting the diagnosis of Gastric Dilitation-Volvulus (GDV). The animal arrested and died intra-operatively and was submitted for necropsy, with lesions supportive of the diagnosis of GDV. No risk factors for GDV were found to correlate between the panda and those described in domestic dogs. This case suggests that red pandas can be susceptible to this condition in captive settings.
The Journal of veterinary medical science / the Japanese Society of Veterinary Science.J Vet Med Sci.2014 Feb 10. [Epub ahead of print]
A 10 year-old male red panda presented acutely with symptoms of shock due to acute abdominal distress and respiratory compromise. Abdominal ultrasound confirmed a severely distended stomach for which passage of an orogastric tube for relief was unsuccessful. Intra-operatively, the stomach was found
PMID 24521795

Cecal Volvulus Diagnosed on CT in Two Distinct Clinical Settings.

Farnam J1, Wallach M2.
Rhode Island medical journal (2013).R I Med J (2013).2014 Feb 3;97(2):45-7.
PMID 24494215

Japanese Journal

症例総腸間膜症に伴ったS状結腸軸捻転症に対して待機的に腹腔鏡下S状結腸切除術を施行した1例

神谷忠宏,寺崎正起,岡本好史 [他]
外科 = Surgey : 臨床雑誌 77(4), 480-483, 2015-04
NAID 40020404896

症例再発性S状結腸軸捻転症に対して待機的腹腔鏡補助下結腸切除術を行った2例

鬼塚幸治,福山時彦,三浦哲史 [他]
外科 = Surgey : 臨床雑誌 77(4), 476-479, 2015-04
NAID 40020404887

症例繰り返す慢性偽性腸閉塞症憎悪のうち二度は腸管捻転が原因で外科的治療を要した1例

古元克好,山根佳,宮内雄也 [他]
外科 = Surgey : 臨床雑誌 77(3), 351-355, 2015-03
NAID 40020370676

Related Pictures

★リンクテーブル★

リンク元	「100Cases 60」「腸軸捻転」
拡張検索	「stomach volvulus」「O. volvulus」「Onchocerca volvulus」「intestinal volvulus」

「100Cases 60」

Volvulus
	Classification and external resources
	; Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock
ICD-10	K56.2
ICD-9	537.3, 560.2
DiseasesDB	13996
eMedicine	ped/2415
MeSH	D045822

　　[★]

attend

vt.

～に出席/参列する、(学校に)行く(go toより堅い語)

The normal ECG and chest X-ray when he attended hospital after an episode do not rule out an intermittent conduction problem.

(結果として)～に伴う

～に同行/同伴する、付き添う、仕える。往診する。～の世話をする、～に気をつける、見張る

vi.

出席/参列/出勤する(at)

留意/注目/傾聴する(to)。身を入れる、勢力を注ぐ、心を傾注する(to)。世話をする、気を配る(to)

仕える、付きそう(on)。(危険・困難などが)伴う(on)

productive

adj

生産的な、生産力を有する(⇔unproductive
(擦過が)他作の。(土地などが)多産の、豊富に算出する
[叙述](～を)引き起こす、もたらす(of)
(事業などが)利益をもたらす、営利的な。良い結果をもたらす、実りの多い
(言語)(接辞などが)生産性のある
(医学)(咳が)喀痰を伴う。(炎症が)増殖性の

outflow

n.

流出/流出物。流出量

vi.

流出する

obstruction

n.

妨害、障害、支障、差し障り(to)。妨害物、

obstruction to outflow

the clinical picture suggests obstruction to outflow from the stomach.(この臨床像は胃流出障害を示唆している)

閉塞、閉塞症。

obstruction to outflow

流出障害

ex.

the clinical picture suggests obstruction to outflow from the stomach.(この臨床像は胃流出障害を示唆している)

aqueous outflow from the eye (眼球からの房水流出)

retain

re + tent (tineo=teneo) = to hold back

vt.

保持する、保有する、保留する、持ち続ける、維持する。(使用のために)確保しておく
(ある場所に)保つ、保持する。(熱などを)保っている、失わないでいる
忘れないでいる、覚えている
(弁護士・気腫・召使いなどを)雇っておく、抱える
使用/実行し続ける。(廃止しないで)そのままにしておく

palliation

n.

寛解、緩和

n.

強く揺り動かすこと、強く揺れること

splash

n.

はね返し、はねかけ。はねかす音。

どっと流れる水。

□unit

1 unit = 10 ml of ethanol

□350ml アルコール5%

350x0.05/10=1.75 unit

http://pohwa.adam.ne.jp/you/hobby/ryori/sake2.ht ml

1unitの量が国によって違う。純エタノール換算で、1英unitは8g=10ml（英糖尿病協会採用の数値）、1米unitは15g（20ml弱：1drinkとも）で、日本では10～14g程度（代謝熱量80Kcalが基準：食品成分表5訂版,2002）や20ないし23g（日本酒1合分）を1unitとしている。日本の医学界では1unit=20g（体積に換算すると25ml）を採用することが多いので、ここでもそれに従う。この基準（1unit=20g=25ml）で計算すると、40度のウィスキー1ショット（＝1オンス：英液量オンスで28.41ml、米液量オンスで29.57ml、日本の1ショットで30ml）が約0.5unitとなる。5度のビールなら500mlでだいたい1unit（この、日本酒1合≒ウィスキーダブル≒ビール500cc≒1unitという関係は、覚えておくと便利かもしれない：ワインなどは日本酒に準じるので、1本750mlがだいたい4unit強である）。

主訴：体重減少

(主訴にまつわる症状)

　・4ヶ月で10kg減少、食欲の減少、嘔吐(頻度：次第に増えてきている。嘔吐物と量：何時間も前に食べたものを多量に嘔吐する)

(主訴以外の症状)

　・一ヶ月前から脱力感(部位：特に下肢で著しい(丘に登ったり、階段を上ったりするとき))

嗜好歴：喫煙 20/day、飲酒 10units/week (ビール 6本弱)

家族歴：なし

既往歴：高血圧(2年間β遮断薬で治療、4ヶ月前に服薬中止)

身体所見 examination

バイタル：82/分、血圧 148/86 mmHg

全身：やせ、体調が悪そう(unwell)。

呼吸器、心血管系に異常なし

腹部：腫瘤触知せず、圧痛なし、振盪音/振水音を認める

検査所見 investigations

低値：ナトリウム、カリウム、クロライド、尿素

高値：重炭酸

Q

1. これらの所見の説明は？

2. もっともな診断は？

A

★

　胃流出路の閉塞　＝　食後の嘔吐　＋　胃の振水音

　高BUN　＋　低CRE　→　脱水

　低Na,Cl,H+　→　嘔吐

　HClの喪失　→　代謝性アルカローシス

　　H：細胞内→外

　　K：細胞外→内

　　従って、低カリウム血症　→　筋力低下・脱力

★

　胃流出路の閉塞の原因：胃癌とか胃潰瘍による瘢痕

　診断には上部消化管内視鏡・生検(組織診)、その後にCT(局所浸潤、転移巣検索)

　治療法：腫瘍だったら腹腔鏡による腫瘍の摘出術。その他の場合は手術をしたり、薬物療法をしたり、、、

学習ポイント

・嘔吐・嘔気 nausea and vomiting DIF.321, vomitus DIF.449 IMD.351

解剖で考えよう。縦に解剖、横に病因

鼻咽頭　扁桃、外来異物

食道　アカラシア、逆流性食道炎、食道癌　・・・嚥下困難があるはず

胃　胃炎、消化性潰瘍、胃癌、幽門部の病変(ポリープ、癌、潰瘍；胃の出口を閉塞させる)。子供だったら幽門狭窄症

十二指腸：潰瘍、十二指腸炎、Billroth II法による輸出脚の閉塞、Billroth I/II法によるダンピング症候群。胆汁性胃炎も原因となる。

小腸：小腸閉塞(腸重積、腸回転異常症、胃石症、癌腫、限局性回腸炎)

結腸：潰瘍性大腸炎、アメーバ症、腫瘍男。腸間膜動脈血栓症、

消化管全体：Strongyloides, Ascaris, Taenia solium

・β遮断薬の服用中止で何が起こる？

　狭心症や発作性の高血圧。

　なんでやめたんだろう？　→　副作用：(1%程度に)めまい、全身倦怠感、頭痛、徐脈が出現

・振盪音

　腹水や胃内容物の貯留によって聴取される。

・BUN 高値、Cre 低値

suggest a degree of dehydration

・BUN

==検査値の異常 (異常値の出るメカニズム第5版 p.144)==

===BUN 上昇===

1. 組織の異化亢進

外科的大手術、体内への出血、異型輸血、悪性腫瘍、飢餓時、高熱、高度熱傷、アジソン病のクリーゼ、糖尿病性アシドーシス、甲状腺機能亢進症、膵臓壊死、重症感染症

2. 蛋白摂取量の増加
3. 消化管出血

赤血球・血漿蛋白が腸管内で分解　→　分解されて生成するNH<sub>3</sub>が小腸で吸収される　→ BUN↑

4. 腎血流量の減少

重症心不全、ショック

5. 腎障害

尿素排泄機能が低下

6. 尿路の閉塞

腎後性に尿排泄が阻害されると尿素が血液中にうっ滞する。

「腸軸捻転」

　　[★]

英: volvulus volvulus of the intestine
同: 腸軸捻転症 torsion of the bowel、腸捻転症　 volvulus、腸捻転、軸捻症、腸軸旋症、腸軸転不通症
関

[show details]

腸捻転 : 約 139,000 件
腸軸捻 : 約 17,400 件
腸軸捻転 : 約 123,000 件
腸捻転症 : 約 13,400 件
腸軸捻症 : 約 95 件
腸軸捻転症 : 約 59,500 件

「stomach volvulus」

　　[★]

胃捻転、胃軸捻転

関: gastric volvulus

「O. volvulus」

　　[★]

回旋糸状虫

関: Onchocerca volvulus

「Onchocerca volvulus」

　　[★]

関: Onchocerciasis

-回旋糸状虫

「intestinal volvulus」

　　[★]

腸捻転

関: volvulus

[0] "volvulus" at Dorland's Medical Dictionary

[MTS-1] Wedding, Mary Ellen; Gylys, Barbara A. (2004). Medical Terminology Systems: A Body Systems Approach (Medical Terminology (W/CD & CD-ROM) (Davis)). Philadelphia, Pa: F. A. Davis Company. ISBN 0-8036-1249-4.

[2] Mayo Clinic Staff (2006-10-13). "Redundant colon: A health concern?". Ask a Digestive System Specialist. MayoClinic.com. Archived from the original on 2007-09-29. http://web.archive.org/web/20070929110621/http://www.mayoclinic.com/health/redundant-colon/AN00239/rss=1. Retrieved 2007-06-11.

[pmid14971995-3] Turan M, Sen M, Karadayi K, et al. (January 2004). "Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process". Rev Esp Enferm Dig 96 (1): 32–5. PMID 14971995. http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=456022&TO=RVN&Eng=1.

[4] Hoffman, Gary H. (2007-08-16). "Diverticulosis/Diverticulitis - For Physicians". Time To Call The Surgeon?. Los Angeles Colon and Rectal Surgical Associates. LAcolon.com. http://www.lacolon.com/patient-education/diverticulosis-and-diverticulitis. Retrieved 20012-07-07.

[5] Hoffman, Gary H. (2009-10-27). "What is Constipation?". What Can Be Done About Constipation. Los Angeles Colon and Rectal Surgical Associates. LAcolon.com. http://www.lacolon.com/conditions/constipation. Retrieved 20012-07-06.

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