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Obstruction and ischaemia due to caecal volvulus in Huntington's chorea
Oclusión e isquemia por vólvulo de ciego en corea de Huntington
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No signs of pneumoperitoneum.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">45-year-old woman diagnosed with advanced Huntington's chorea. She went to the A&E due to vomiting, with nondescript abdominal examination and digital rectal examination. The abdominal X-ray (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed loop dilation, so conservative treatment was initiated.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In the absence of improvement, a CT scan was (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) performed 2<span class="elsevierStyleHsp" style=""></span>h later, revealing intestinal occlusion. Emergency surgery was scheduled, in the course of which a volvulated and ischaemic right colon was observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A right hemicolectomy and mechanical isoperistaltic L-L anastomosis were performed. The patient was discharged without complications.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Huntington's chorea has an incidence of 1–2 cases/million.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> It presents involvement of the enteric neurons, causing intestinal hypomotility and chronic constipation.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Caecal volvulus has an incidence of 3–7 cases/million,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> representing 1–2% of intestinal obstructions. Treatment is initially conservative with the placement of a nasogastric tube.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a>If symptoms persist, devolvulation by colonoscopy can be considered, although it was ruled out in this case due to pneumatosis and risk of perforation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Laparotomy is indicated in cases of absence of improvement or worsening given the high risk of ischaemia and necrosis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The association between both diseases is not described in the literature. Caecal volvulus should be suspected in occlusive conditions in these patients in whom, as they present less pain, the diagnosis is more difficult and delayed.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ferrer-Inaebnit E, Segura-Sampedro JJ, Molina-Romero FX, González-Argenté X. Oclusión e isquemia por vólvulo de ciego en corea de Huntington. Gastroenterol Hepatol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.gastrohep.2020.03.005">https://doi.org/10.1016/j.gastrohep.2020.03.005</span></p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 975 "Tamanyo" => 98953 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal X-ray: significant dilation of loops with breadcrumb pattern occupying the entire abdomen, rendering it impossible to rule out a gastric origin. No signs of pneumoperitoneum.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 975 "Ancho" => 975 "Tamanyo" => 66240 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT scan: marked dilatation of the intestinal loops in the small intestine together with pneumatosis, with preserved mural enhancement. A change in calibre is observed in the right flank with engorgement of vessels associated with this level, without pneumoperitoneum.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 732 "Ancho" => 975 "Tamanyo" => 117254 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Right colon volvulated on the ileocolonic axis with several plaques of transmural necrosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early enteric neuron dysfunction in mouse and human Huntington disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Sciacca" 1 => "M. Favellato" 2 => "M. Madonna" 3 => "D. Metro" 4 => "M. Marano" 5 => "F. Squiteri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.parkreldis.2016.10.017" "Revista" => array:4 [ "tituloSerie" => "Parkinsonism Relat Disord" "fecha" => "2017" "paginaInicial" => "73" "paginaFinal" => "74" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence and the burden of pain in patients with Huntington disease: A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.P. Sprenger" 1 => "K.F. Zwaan" 2 => "Van Der" 3 => "R.A.C. Roos" 4 => "W.P. Achterberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/j.pain.0000000000001472" "Revista" => array:7 [ "tituloSerie" => "Pain" "fecha" => "2019" "volumen" => "160" "paginaInicial" => "773" "paginaFinal" => "783" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30889051" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002914915011121" "estado" => "S300" "issn" => "00029149" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cecal bascule: a systematic review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.E.L.S.B. Yelika" 1 => "A.S.M.M. Gachabayov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10151-017-1725-6" "Revista" => array:6 [ "tituloSerie" => "Tech Coloproctol" "fecha" => "2018" "volumen" => "22" "paginaInicial" => "75" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29159782" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004300000010/v3_202102250818/S2444382420301838/v3_202102250818/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004300000010/v3_202102250818/S2444382420301838/v3_202102250818/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382420301838?idApp=UINPBA00004N" ]
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