Ileosigmoid knotting in patients under 25 years of age: A report of two cases

INTRODUCTION

Ileosigmoid knotting is a rare cause of acute abdomen with high morbidity and mortality. Its diagnosis is infrequently made before surgery because of its varying ways of presentation and rarity.

PRESENTATION OF CASE

The first was a 21-year-old male who presented with a history of sudden generalized abdominal pain and progressive abdominal distension. He was pale and severely dehydrated. His extremities were cold and clammy. His pulse rate was 110 per minute and blood pressure was 90/50 mmHg.The second case was 20-year-old male who presented with similar symptoms as above. He was not pale but mildly dehydrated. His pulse rate was 92 per minute and blood pressure 110/70 mmHg.Both patients were resuscitated and had exploratory laparotomy a few hours after presentation. The first patient was found to have ileosigmoid knotting with gangrenous sigmoid colon and terminal ileum. He had Hartmann''s procedure and right hemicolectomy with ileo-transverse anastomosis.The second patient was found to have ileosigmoid knotting with viable loops of bowel. He had careful detorsion, sigmoidectomy with primary anastomosis. Both patients’ have good outcome.

DISCUSSION

This is to report two cases of ileosigmoid knotting in two male patients aged 21 and 20 years, respectively, with the hope of increasing awareness.

CONCLUSION

Ileosigmoid knotting though more common in fourth or fifth decade of life, can also occur in the 2nd decade. Early diagnosis, careful resuscitation and skilful surgical intervention will improve outcome.     

Prognosis of carcinoma of the breast in women under 25 years of age.

In 1960 to 1969 twenty six women below 25 years were operated on because of mammary carcinoma. All eighteen patients in stage 0 and I had a five-year cure. The corresponding rate for seven women in stage II was 43%. Of eight women with a poorly differentiated or anaplastic growth, 38% survived for more than five years. The corresponding figure for those with a well differentiated tumour was 100%. The prognosis in young women is thus good provided the malignant breast tumour is diagnosed and treated in good time, and it is better than that in elderly women.     

Bidirectional cavopulmonary anastomosis in patients under two years of age.

Between December 1986 and December 1990, a bidirectional cavopulmonary anastomosis was performed in 27 patients younger than 2 years of age, including 12 with heterotaxia syndrome. Age and weight of patients averaged 14.2 +/- 6.6 months and 8.1 +/- 2.2 kg, respectively. Eleven had pulmonary atresia and 16 had pulmonary stenosis. The main pulmonary artery was ligated in seven patients in the latter group (subsequently reopened in one) and left open in nine (subsequently ligated in two). There were four hospital deaths (15%). All patients were discharged with anticoagulant/antithrombotic therapy to be continued for 6 months. There were two late deaths before further operations (8.7%). Two patients, one with acquired massive pulmonary arteriovenous fistulas and one with progressive common atrioventricular valve regurgitation, subsequently underwent definitive repair (biventricular in one), and both died. Heterotaxia syndrome (p = 0.087) and preoperative mean pulmonary artery pressure higher than 15 mm Hg (p = 0.09) were the only risk factors for overall mortality.     

Lumbar disc herniation in patients up to 25 years of age

Retrospective analysis of 165 patients (105 males, 60 females) with a mean age of 21.2 years (range 14 to 25 years) of 6933 surgically treated patients from January 1987 to May 1999 focused on age and sex distribution, body mass, familial predisposition, trauma, histology, and clinical course. The incidence of herniated lumbar discs was 2.3% in patients aged up to 25 years. A valid family history was obtained in 121 patients and a positive history was found in 82 of these patients (67.8%). The patients had a higher body mass index compared to a group of individuals with a similar age structure. Radiography demonstrated bony changes in 124 patients (75.2%), primarily attributable to postural deformities such as scoliosis. The condition of the bony structures seems to be more important than the condition of the disc tissue in the occurrence of this disease in young patients.     

Genitourinary tuberculosis in patients under twenty-five years of age

There were 29 patients under the age of twenty-five years in a series of 230 patients with genitourinary tuberculosis. Younger patients were less likely to have had previous tuberculosis but more likely to have a family history of tuberculosis. Abdominal or loin pain was a more common presenting feature in those under twenty five, and they were less likely to require surgery than older patients.     

Bladder cancer in patients under fifty years of age

Fifty-five cases of carcinoma of the bladder in the age group under fifty years have been reviewed. Seventy three percent of their tumors were low grade and low stage transitional cell carcinoma. Mainly, TUR was performed on these patients and their five year relative survival rate was 97.6%. The recurrence rate after TUR was 16%.     

Superficial bladder tumors in patients under 40 years of age: clinical, prognostic and cytogenetic aspects

Bladder carcinoma with transitional cells is the most frequent neoplasia in the urinary system, but it is quite rare in patients under 40 years of age (0.4-2%). An analysis of 21 patients under 40 and a review of other reports show that tumors in patients under 20 years old have little tendency to recur and to progress, while tumors in patients aged between 21 and 40 have a behavior pattern similar to older age groups regarding recurrence and disease progression. Preliminary results of a study using fluorescent in situ hybridization with probes for the centromere of chromosomes 7 and 17 showed a high incidence of aneusomy with regard to these chromosomes and a genetic difference between superficial tumors in the young and in adults. Using probes from chromosomes already described in bladder carcinogenesis, we obtained higher sensitivity and specificity in detecting aneuploid events.     

Transitional cell carcinoma of bladder in patients under thirty years of age.

Seventy-nine cases of transitional cell carcinoma of the bladder in the age group under thirty years have been reviewed. The diagnosis and treatment are the same as in the older age group. The tumors are usually of low grade and low stage, but they can become more aggressive and more malignant. Contrary to previously held beliefs that transitional cell tumors in the younger age group rarely if ever recur, this series had a recurrence rate of 13.9 per cent with several patients having multiple recurrences. Therefore, the follow-up care of these patients must be vigilant and persistent.     

5-fluorouracil in trabeculectomy for patients under the age of 40 years.

In an attempt to enhance the success of trabeculectomy in patients under 40 years old, beginning 48 hours after surgery, we injected 5 to 45 mg (mean, 35 mg) of 5-fluorouracil in 10 eyes of six patients. After a mean follow up of 14.9 months (range, 6 to 27 months), intraocular pressure was below 21 mm Hg in 9 of the 10 eyes, with no antiglaucoma medication.     

Coronary artery bypass in patients under 40 years of age

Coronary artery bypass surgery was performed in 92 patients, ranging in age from 20 to 40 years. The male-to-female ratio was 5:1. The operative mortality was 3.3%. Sixty-two patients were followed up for a mean of 3.5 years. Complete relief of angina was reported by 79% of patients and an additional 10% experienced some improvement. The survival rate at 3.5 years was 97%. The results favour myocardial revascularization in young adults.     

Acute colonic diverticulitis in patients under 50 years of age

BACKGROUND: There is ongoing controversy concerning the virulence and management of diverticulitis in young patients. This study reports on the management of acute diverticulitis with reference to the virulence and outcome of the disease with respect to age. METHODS: Between January 1994 and June 1999, 327 patients were treated for acute left colonic diverticulitis. Patients were divided in two groups: those aged 50 years or less (group 1, 72 patients) and those older than 50 years (group 2, 255 patients). The diagnosis was confirmed histologically or radiologically in all patients. RESULTS: There were differences in gender distribution related to age (P < 0.001). During the first hospital stay, 226 patients (69.1 per cent) had successful conservative treatment, 78 (23.9 per cent) needed emergency surgery and 23 (7.0 per cent) had a semielective operation (P = 0.47). The recurrence rate was 25.5 per cent in group 1 and 22.3 per cent in group 2 (P = 0.93). The type of surgical procedure and grade of peritonitis in emergency patients were similar in the two groups. Overall the mortality rate in patients who underwent an operation was 16.3 per cent. The mortality rate was zero in group 1 and 2.2 per cent in group 2 after elective or semielective operation (P = 1.0), and zero in group 1 and 34.9 per cent in group 2 after emergency operation (P < 0.001). CONCLUSION: Diverticulitis in young patients does not have a particularly aggressive course and the risk of recurrence is similar to that of older patients.     

Transitional cell carcinoma in patients under forty years of age

Transitional cell carcinoma of the urinary tract in patients under the age of 40 is often thought to be a milder form than in the older age groups. However, the literature provides little information on this and is contradictory. We report a series which shows that there is a significant recurrence rate, albeit less than in those aged over 40. The tumours were predominantly low grade and low stage and none could be described as aggressive.     

Review of colorectal cancer in patients under age 40 years

Brooke Army Medical Center Tumor Registry records from 1947 through 1980 were reviewed. One hundred forty of 819 patients with colorectal cancer were aged 40 or less. The 5 year survival rate was 35 percent and the 10 year survival rate 32 percent. The predominant presenting symptoms were bleeding, pain and change of bowel habits. The median duration of symptoms was 3 months. There were no Dukes' A patients. The 5 and 10 year survival rates in 19 Dukes' B patients were 67 percent. Thirty-three Dukes' C patients had 5 and 10 year survival rates of 37 and 30 percent, respectively. In 42 Dukes' D patients, however, there were no 5 year survivors, and the mean length of survival was only 10 months. Our findings support previous surveys which have concluded that stage at the time of diagnosis, rather than symptoms, duration or patient age, is the most accurate prognostic factor.     

Charnley low-frictional torque arthroplasty in patients under the age of 51 years. Follow-up to 33 years

Between November 1962 and December 1990 a group of 1092 patients, 668 women and 424 men, under the age of 51 years at the time of surgery, underwent 1434 primary Charnley low-frictional torque arthroplasties and are being followed up indefinitely. Their mean age at operation was 41 years (12 to 51). At the latest review in June 2001 the mean follow-up had been for 15 years 1 month. Of the 1092 patients 54 (66 hips) could not be traced, 124 (169 hips) were known to have died and 220 (248 hips) had had a revision procedure. At a mean follow-up of 17 years and 5 months, 759 patients (951 hips) are still attending. In this group satisfaction with the outcome is 96.2%. The incidence of deep infection for the whole group was 1.67%. It was more common in patients who had had previous surgery (hemi- and total hip arthroplasties excluded), 2.2% compared with 1.5% in those who had not had previous surgery, but this difference was not statistically significant (p = 0.4). There were fewer cases of deep infection if gentamicin-containing cement was used, 0.9% compared with 1.9% in those with plain acrylic cement, but this was not also statistically significant (p = 0.4). There was a significantly higher rate of revision in patients who had had previous hip surgery, 24.8% compared with 14.1% in those who had not had previous surgery (p < 0.001). At the latest review, 1.95% are known to have had at least one dislocation and 0.4% have had a revision for dislocation. The indication for revision was aseptic loosening of the cup (11.7%), aseptic loosening of the stem (4.9%), a fractured stem (1.7%), deep infection (1.5%) and dislocation (0.4%). With revision for any indication as the endpoint the survivorship was 93.7% (92.3 to 95.0) at ten years, 84.7% (82.4 to 87.1) at 15 years, 74.3% (70.5 to 78.0) at 20 years and 55.3% (45.5 to 65.0) at 27 years, when 55 hips remained 'at risk'.     

The hydroxyapatite-coated JRI-furlong hip. Outcome in patients under the age of 55 years

We present the clinical and radiographic outcome of 68 consecutive primary total hip replacements performed in 54 patients under the age of 55 years using a hydroxyapatite-coated femoral component and threaded cup with a modular ceramic head (JRI-Furlong). We reviewed 62 (91%) hips at a median follow-up of 8.8 years (5 to 13.8) after implantation; six (9%) were lost to follow-up. At review there had been four (6%) revisions but only one for aseptic loosening (acetabulum). Radiographic review of the remaining hips did not identify any evidence of femoral or acetabular loosening. The median Harris and Merle d'Aubigné and Postel hip scores were 95.9 (42.7 to 100) and 17 (3 to 18) respectively. The JRI-Furlong hip gives promising functional and radiographic results in young patients in the medium term.     

Osteoarthritis of the hip in patients under 60 years of age

Summary Pain at rest with osteoarthritis of the hip may be due to increased intraosseous blood pressure, which falls immediately after an intertrochanteric osteotomy [4, 5]. Eighty-five consecutive hips from patients under 60 years of age at the time of operation were studied in order to evaluate if pain at rest was an indication for intertrochanteric osteotomy. Patients who preoperatively were predominantly in pain at rest had a significantly better prognosis than patients with a predominantly weight-bearing pain (P < 0.05). Intertrochanteric osteotomy reduced pain for the group of patients with predominant pain at rest (n = 50) by 81%, 66%, and 56% at 5, 10, and 15 years respectively. In the group where weight-bearing pain was predominant (n = 35), the operation was a success in only 39% at 5 years and after.

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Zusammenfassung Nach Arnoldi et al. [4, 5] wird der Dauerschmerz bei der Coxarthrose durch erhöhten intraossären Druck, der unmittelbar nach einer intertrochanteren Osteotomie abnimmt, verursacht. Mit dem Ziel, die Bedeutung des Vorhandenseins von Dauerschmerzen als Indikation zur intertrochanteren Osteotomie zu beurteilen, untersuchten wir ein konsekutives Material, bestehend aus 78 Patienten unter 60 Jahren (85 Hüften) mit einer Coxarthrose. Patienten mit überwiegend Dauerschmerzen hatten eine signifikant bessere Prognose als Patienten mit hauptsächlich Belastungsschmerzen (P < 0.05). Bei den Patienten mit uberwiegend Dauerschmerzen fand man nach 5, 10 and 15 Jahren ein gutes Ergebnis bei 81% bzw. 66% and 56%, während man bei den Patienten, in denen die Belastungsschmerzen dominierten, nach 5 and folgenden Jahren ein gutes Ergebnis nur bei 39% fand.

     

Carcinoma of the lung in patients under 40 years of age

Bronchogenic carcinoma in the young population (40 years of age or less) is reported to present in an advanced stage and to have a virulent course. Between 1969 and 1979, 101 patients (65 men and 36 women) presented with cancer of the lung. Their mean age was 36.2 +/- 3.9 years (range 18 to 40 years). Eighty-seven percent had a history of cigarette smoking. Fifty percent of the patients had a strong familial history of malignancy of several organs. The interval between onset of symptoms and diagnosis was 4.01 +/- 3.48 months (3.56 +/- 3.34 for the surgically treated group and 4.16 +/- 3.53 for the nonoperated or unresectable group). Diagnosis was made at bronchoscopy in 32 patients, during thoracotomy in 30 patients, during nodal biopsy in 28 patients, and on cytologic examination of the sputum in 9 patients. The most common cell types were adenocarcinoma in 39 patients, squamous carcinoma in 29 patients, and oat cell carcinoma in 18 patients. Eighty-six patients (the majority) presented in stage III, whereas 9 were in stage I and 6 were in stage II. Twenty-seven patients (26.7 percent) underwent resection for cure, whereas 18 patients were inoperable at surgery. Eighteen of the surgical patients had adjuvant radiotherapy, and chemotherapy, immunotherapy, or both. The average length of survival for the nonresected patients was 7.12 +/- 5.9 months (range 1 to 36 months) and the actuarial survival was 1.5 percent at 36 months. The survival for the surgically managed patients was 56.1 +/- 52.6 months (range 3 to 168 months) or 48 percent at 36 months. At 46 to 168 months after treatment, the only survivors were 13 patients who were surgically managed. Stage III patients had longer survival after surgery (24.1 +/- 24.6 months to 7.09 +/- 5.90 months; range 3 to 74 months and 1 to 36 months, respectively). The survival at 5 years for patients with stage I disease was 78.8 percent, stage II disease 66.6 percent, and stage III disease, 3.6 percent. Early diagnosis and aggressive surgical management are necessary to improve the survival of patients with bronchogenic carcinoma under 40 years of age.