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This case highlights a 37-year-old woman with primary sclerosing cholangitis awaiting liver transplantation who presented with torsion of a wandering spleen with associated gastric and pancreatic volvulus. The patient underwent emergent exploratory laparotomy with splenectomy. She had an uncomplicated postoperative course and recovered well.

BACKGROUND: The Norwood procedure is the first stage of correction for patients with hypoplastic left heart syndrome (HLHS) and may lead to an abnormal neoaortic anatomy. We prospectively studied the neoaorta’s fluid dynamics and the abnormal twist of the neoaorta by MRI examinations of HLHS patients in Fontan circulation. This study for the first time investigates the hypothesis that the neoaorta twist is associated with increased helical flow patterns, which may lead to an increased workload for the systemic right ventricle (RV) and ultimately to RV hypertrophy. METHODS: A group of forty-two HLHS patients with a median age of 4.9 (2.9–17.0) years, at NYHA I was studied along with a control group of eleven subjects with healthy hearts and a median age of 12.1 (4.0–41.6). All subjects underwent MRI of the thoracic aorta including ECG-gated 2D balanced SSFP cine for an axial slice stack and 4D-flow MRI for a sagittal volume slab covering the thoracic aorta. The twist of the neoaortic arch was quantified by the effective geometric torsion, defined as the product of curvature and geometric torsion. Fluid dynamics and geometry in the neoaorta, including the flow helicity index, were evaluated using an in-house analysis software (MeVisLab-based). Myocardial mass of the systemic ventricle at end-diastole was estimated by planimetry of the short-axis stack. RESULTS: Compared to the control group, the neoaorta in the HLHS patients shows an increased twist (P=0.04) and higher peak helicity density (P=0.03). The maximum helicity density was correlated with maximum effective torsion of the ascending neoaorta (P

Extralobar pulmonary sequestration is a rare congenital pulmonary malformation that may present early in life or remain asymptomatic. Here we present a case of torsion of an extralobar pulmonary sequestration on its vascular pedicle. Although the patient's initial symptomatology suggested intraabdominal pathology, the correct preoperative diagnosis was determined in large part by the lesion's MRI characteristics, which strongly suggested tissue infarction.

Introduction: Torsion of the falciform ligament, one of the rarest causes of acute abdominal pain, often presents with pain in the right upper quadrant and epigastrium. Case Presentation: In this case, we present the Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) findings of torsion of the falciform ligament that occurred in the presence of omental fat herniation through the foramen of Morgagni in an 88-year-old female patient who presented to the emergency department with acute epigastric pain. Conclusion: Torsion of the falciform ligament may develop secondary to omental hernia in the setting of Morgagni hernia and should be taken into consideration as one of the rarest causes of acute abdominal pain, even in elderly patients.

Torsion of the ovary is a rare condition whose diagnosis remains difficult given the non-specificity of the clinical picture as well as the difficulty of clinical evaluation, especially in young girls. It is a surgical emergency because it involves the vital prognosis by the hemorrhagic risk, and functional prognosis by the risk of infertility. The clinical picture is dominated by acute abdominal pain. Our work reports the case of a 2-year-old girl in whom the diagnosis of ovarian torsion was made in front of an atypical clinical picture. Laparoscopy is the method of choice for making a positive diagnosis and performing a conservative procedure as described in this work.

An accessory liver lobe is a congenital anomaly of hepatic tissue most commonly due to embryonic heteroplasia. Rarely, accessory liver lobes can undergo torsion and present as an acute surgical emergency. Although common in certain animals, there are only a few reported cases of accessory lobe torsion in humans. We report a multi-modality radiographic diagnosis of an acute torsion and subsequent infarct of an accessory liver lobe following minor trauma in a 29-year old male patient.

Objectives: To identify the underlying etiology of dermoid cysts in the pouch of Douglas. Case presentation: A 44-year-old woman presented to our clinic complaining of chronic, dull-aching lower abdominal pain of one-month duration. Pelvic ultrasound examination showed an eight-centimeter cystic appearing lesion in the right adnexa. Computed tomography (CT) suggested the diagnosis of dermoid cyst. Laparoscopy revealed a residual ovarian tissue on the right side and an eight-centimeter cystic mass occupying the pouch of Douglas. The entire specimen was removed en bloc through the umbilicus incision inside a bag with no spillage. Histopathologic examination confirmed the diagnosis of a mature cystic teratoma. Conclusion: Parasitic dermoid cysts are extremely rare entity especially those located in the pouch of Douglas. Autoamputation and reimplantation is the most accepted etiology to explain this phenomenon. Key-words: Autoamputation, dermoid cyst, Douglas, Laparoscopy, Mature cystic teratoma

Background Management of ovarian torsion has evolved toward ovarian preservation regardless of ovarian appearance during surgery. However, patients with torsion and an ovarian neoplasm undergo a disproportionately high rate of oophorectomy. Our objectives were to identify factors associated with ovarian torsion among females with an ovarian mass and to determine if torsion is associated with malignancy. Methods A retrospective review of females aged 2-21 y who underwent an operation for an ovarian cyst or neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariate logistic regression was used to assess factors associated with torsion. Imaging data were assessed for sensitivity, specificity, and predictive value in identifying ovarian torsion. Results Of 814 girls with an ovarian neoplasm, 180 (22%) had torsion. In risk-adjusted analyses, patients with a younger age, mass size >5 cm, abdominal pain, and vomiting had an increased likelihood of torsion (P 5 cm had two times the odds of torsion (odds ratio: 2.1; confidence interval: 1.2, 3.6). Imaging was not reliable at identifying torsion (sensitivity 34%, positive predictive value 49%) or excluding torsion (specificity 72%, negative predictive value 87%). The rates of malignancy were lower in those with an ovarian mass and torsion than those without torsion (10% versus 17%, P = 0.01). Among the 180 girls with torsion and a mass, 48% underwent oophorectomy of which 14% (n = 12) had a malignancy. Conclusions In females with an ovarian neoplasm, torsion is not associated with an increased risk of malignancy and ovarian preservation should be considered.

Color flow Doppler ultrasound is a critical tool in the assessment of the scrotum. Ultrasound is the first-line imaging modality and can rapidly differentiate between surgical and nonsurgical conditions, allowing for appropriate and prompt patient management. We review the role of color flow Doppler in the evaluation of acute scrotal pain, highlighting some of the most commonly seen pathologies such as epididymo-orchitis and testicular torsion.

Objective: To determine clinical factors that are associated with an increased likelihood of having oophorectomy at the time of surgery in patients with suspected ovarian torsion (OT). Design: This...

Testicular torsion is an emergency urological condition that is caused by the torsion of the spermatic cord structures, causing disruption of circulation of the affected testicle. This study aimed to describe the characteristics of patients with testicular torsion treated at Dr. Hasan Sadikin General Hospital Bandung from January 2016 to January 2020. This was a retrospective descriptive study on 34 medical records of patients diagnosed and treated for testicular torsion. Nine patients (29.4%) were 21 years old. The onset was mostly between 6 to 24 hours (38.2%), followed by between 2–7 days (23.5%), less than 6 hours (20.6%), between 1–2 weeks (8.8%), and between 2–4 weeks (8.8%). Left testicular torsion were more frequent than the right torsion (61.8% vs. 38.2%). The etiology of the torsion was mostly idiopathic with no identifiable precedent (88%). Orchidectomy was more frequently performed compared to orchiopexy (78.4% vs. 21.6%). All but one patient (97.1%) presented with testicular pain as the main symptom. Patients presented mostly with a high risk TWIST score (64.7%); however, more presented with low risk compared to the intermediate risk TWIST score (26.5% vs. 8.8%). Orchidectomy is the most frequently performed operation on pre-pubertal and adult patients, possibly due to relatively delayed presentation (>24 hours) to the hospital to receive treatment. Patients were mostly younger; predominantly with high TWIST score and affected left testicle.

Ahmed Adam Osman,1 Mehmet Tahtabasi,1 Ismail Gedi Ibrahim,1 Ahmed Issak Hussein,2 Ismail Mohamud Abdullahi3 1Department of Radiology, University of Health Sciences, Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia; 2Department of Obstetrics and Gynecology, University of Health Sciences, Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia; 3Department of Pathology, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, SomaliaCorrespondence: Mehmet TahtabasiSomalia Recep Tayyip Erdogan Education and Research Hospital, 30 Street, Black Sea, Hodan District, Mogadishu, SomaliaTel +905076159932Email mehmet.tahtabasi@sbu.edu.trAbstract: Mature cystic teratoma (MCT) is a benign and unilateral ovarian neoplasm usually seen in premenopausal women. Its most common complication, torsion, is a well-known cause of acute abdominal pain. However, it is rare in the early postpartum period. In this paper, we present a case of ovarian torsion due to MCT, which was diagnosed radiologically in the early postnatal period and surgically confirmed. A 25-year-old woman vaginally delivered a healthy baby on time and without any problems. She presented with acute abdominal pain in the right lower quadrant on the postpartum 5th day. Abdominal ultrasound (US) and computed tomography (CT) demonstrated an ovarian mass containing fat and calcification in the right adnexa and non-enhancing ovarian parenchyma. The patient was discharged on the 5th day after the salpingo-oophorectomy operation without any complications. US and CT provided crucial information to make an accurate and rapid management decision in ovarian torsion due to MCT.Keywords: adnexal torsion, mature cystic teratoma, early postpartum, pregnancy, computed tomography

Back ground: Humerus is the longest of the long bones of superior extremity.It”s head articulates with scapular glenoid cavity to form the gleno-humeral/Shoulder joint.The rounded head of Humerus is too weakly supported in the scapular glenoid cavity lined by glenoid labrum which makes it the most mobile and most unstable nd joint and so most commonly dislocated joint of the human body.Also the humeral head part is the 2 most important part of shoulder arthroplasty. Aim of the study is to make a clinical evaluation of parameters used in prosthesis design for the humeral component applied in arthroplasty of the proximal upper extremity. Methods: A total of 100 (Rt -58,Lt –42 ) dry human Humerus available in the Department of Anatomy of Calcutta National Medical College,Kolkata,West Bengal and Nilratan Sircar Medical College,Kolkata,West Bengal were taken for the study.The Humeral heads are measured in supero-inferior(SI) diameter, and antero-posterior diameter(AP), The width of Humeral head (Wdth),and angle of Humeral Torsion were measured. At the very beginning the both sided Humerus taken for the study are properly numbered using permanent marker pen.The width of the Humeral head(Wdth) is measured 1stly by pressing the head in modelling dough and when the mould is prepared,semisolid plaster of paris is lled into the mould. After drying the replica of humeral head is smoothened upto the mark of anatomical neck of humerus thus proper width can be measured. The superoinferior(SI) diameter, and antero-posterior diameter(AP) were measured by digital slide callipers by placing it directly onto the surface of consequently numbered humeral heads. The width of Humeral head (Wdth ) were measured from these replica(properly numbered) humeral heads, made of plaster of paris at the middle, the highest thickness was measured. The measurements are taken via spreading slide calipers in milimeters. For measuring the angle of humeral angle of torsion ,we xedly placed the humerus on to a area over the smooth part of the vertical wall which was meeting another horizontal wall at 90 degrees angle thus the line joining the two epicondyles of humerus lies parallel to the vertical wall.Now placing the straight edge of the protractor onto the upper end of humerus the angle of humeral torsion is measured. Results: Both sided Humerae were analysed separately for Morphological measurement, and angle of Humeral torsion.Mean values for SI were 41.31+3.46mm (Right side) and 40.91+3.27mm(Left side). Mean values for AP were 38.27+3.05mm (Right side) and 37.91+2.70mm(Left side). Conclusion: This study will contribute some relevant data and help the orthopaeditians in dealing with cases of shoulder pathology and shoulder arthroplasty cases.

Introduction. Currently, a modern tactics as to the treatment of testicular appendix torsion in children is not an indisputable axiom but it is a subject of discussion in domestic and foreign literature. Modern diagnostic tools, wide implementation of expert-class equipment as well as gaining more experience have reduced, to a minimum , the risk of diagnostic error with fatal consequences for the gonad. So, it impels to revise the existing algorithms and to consider the conservative treatment as the method of choice in uncomplicated testicular appendix torsion.Objective. To analyze the gained experience in treating testicular appendix torsion and to suggest reasonable algorithms which correspond to modern diagnostic techniques and treatment options. Material and methods. 2875 cases with testicular appendix torsion have been analyzed. Of these, 2 069 (71.96%) patients were operated on; 755 (26.26%) patients had conservative treatment and 51 (1.78%) had to be operated on despite conservative treatment.Results. The material obtained in three statistically homogeneous groups has been аnalyzed. When comparing clinical and ultrasound criteria, it was found out that the incidence of orchalgia in the surgical group is slightly higher than in the conservative one. It may indicate that the adhesive process in the scrotal cavity after surgical trauma is more frequent than after a possible aseptic inflammation. Asymmetry of gonad volumes with smaller diseased testicle was seen in all groups. The decrease in testicular volume is minimal in all cases and is not statistically significant. The incidence of heterogeneity in the testicular and appendage echo structure, which indicates sclerotic changes in the parenchyma, is also not statistically significant in the analyzed groups. Patients who were operated despite their conservative care do not have much worse outcomes after long-lasting follow-up period than groups with other curative options.Conclusion. Torsion of the testicular appendix in children is a challenging problem that is far from being solved. There is no consensus as to the indications for surgical treatment and to the assessment of postoperative outcomes. Modern diagnostic and monitoring techniques allow to dynamically monitor the scrotal organs in conservative treatment. The conservative treatment of testicular appendix torsion is an effective and safe method. The conservative tactics which was changed for surgical one does not lead to gonad deterioration.

Serous cystadenofibromas are benign surface epithelial stromal tumors of the ovary. Many of the sonographic features of serous cystadenofibromas mimic what are traditionally considered possible characteristics of malignancy. Depending on the size of the ovarian neoplasm, there can be increased risk for ovarian torsion. Meticulous sonographic evaluation and appropriate optimization are critical for establishing the risk for malignancy and likelihood of torsion. This case describes how sonography was used to help identify a serous cystadenofibroma in a postmenopausal woman.

The current study was designed to investigate the effect of eugenol on histopathological changes and oxidative stress caused by torsion/detorsion in the ovary of adult female rats. In this study, forty-eight female Wistar rats were classified into six groups; Sham and 2 healthy group receiving 30, 60 mg/kg eugenol; ovarian torsion/detorsion; and 2 experimental groups receiving 30, 60 mg/kg eugenol. After ten days, the plasma levels of oestrogen, testosterone, and some oxidative stress markers were assessed. also, the histomorphometric study was performed. A marked degenerative changes in the TD group was observed (

Summary Objective We aim by this article to present a literature review on the anatomical risk factors for spermatic cord torsion and their involvement the different techniques of orchidopexy. Materials and methods The literature review was conducted following PRISMA check-list, using PubMed database and the Mesh terms: testis, torsion, anomaly, orchidopexy. Techniques of surgical management provided by the EMC (French medico-surgical encyclopedia) were also used. Results Database research identified 500 articles, and 16 mores articles were added from the review of the references lists of relevant articles. At the end, 42 articles were useful for our review including 6 reviews, 5 cross-sectional studies, 14 cohorts, 10 case reports, 1 meta-analysis, 1 letter, and 5 experimental studies. High insertion of the tunica vaginalis, a long mesorchium, deficient attachment of the epididymis to the testis, and anomalies of the gubernaculum testis are the anatomical predispositions for spermatic cord torsion. After reduction of torsion, many surgical techniques for the fixation of the testis have been suggested including: conventional technique by triangulation with or without fasciotomy, window orchidopexy, scrotal pouch, and vaginal eversion with or without dartos fixation. Conclusion The most common anatomical factor associated with spermatic cord torsion is the high insertion of the tunica vaginalis. Vaginal eversion with fixation to the dartos might be superior to other known techniques and seems promising to become standard.

Nerve torsion is a recognized etiology in brachial and peripheral neuropathy. Vascular compromise of peripheral nerves is uncommon given their unique vascular supply. Preoperative imaging diagnosis of nerve torsion and vascular compromise can be made in some cases, which impacts treatment. We present a previously unreported case of long segment torsion and vascular compromise of the ulnar nerve following anterior subcutaneous transposition with a description of the imaging findings based on the unique structure of the nerve and the presence of a blood nerve barrier (BNB) and a discussion of the potential vulnerability of a transposed and torsed nerve.

The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.

OBJECTIVE The aim: The study of pathomorphological changes in uterine appendages during torsion of different duration and after their detorsion in the experiment on rats. PATIENTS AND METHODS Materials and methods: Experimental studies were performed on the basis of vivarium in the conditions of chronic experiment on 48 females of outbred white rats weighing 200.0 ± 20.0 grams.The essence of the experimental model is that the female rats, under the ketamine's anesthesia at the rate of 1-2 mg / kg of the drug, conduct a right-sided ovary twist at 7200 in the projection of the oviduct with fixation of the organs with an external clip of indifferent metal. RESULTS Results: After ovarian detorsion, until 72 hours after its torsion, reliable reversible restoration of the structural components of the ovary is determined as a positive consequence of the effect of the correction factor (detorsion). CONCLUSION Conclusions: The data obtained in the experiment showed that there was a discrepancy between the macroscopic features of the twisted uterine appendages and the microscopic changes in their morphological examination. Despite the presence of external signs of necrosis in the tissue of the uterine appendages, after the detorsion and the restoration of blood flow in them, studies have shown the possibility of performing organ-saving surgical operations in the torsion of the uterine appendages.

Torsion of a pedunculated subserous leiomyoma in a pregnant woman is a rare condition that requires prompt diagnosis and urgent surgical intervention. In this report, we present a case of torsion of a pedunculated subserous leiomyoma in a primigravid woman aged 33 years in her 30th week of gestation. A primigravid woman aged 33 years presented to our clinic in her 30th week of gestation with pain in the right lower quadrant that had developed in the last 24 hours. Our diagnosis was torsion of a pedunculated leiomyoma. The patient received a tocolytic of nifedipine and indomethacin preoperatively. Given the volume of the uterus and as a precaution to potential complications, a lower transverse (pfannenstiel) incision was preferred. The laparotomic myomectomy was successfully performed and the pregnancy continued uneventfully. Even though torsion of a pedunculated subserous leiomyoma in pregnancy is a very rare condition, prompt diagnosis and urgent surgical intervention is life saving and provides more favorable maternal and fetal outcomes. The surgical approach should be tailored to the patient and to the characteristics of the myoma and an expert team of surgeons and anesthesiologists is essential in order to reduce the risk of complications.

Purpose: Although inguinal hernia repair is common in infants, few studies have focused on the condition in female infants. In female infantile inguinal hernia, there is a risk of oophorectomy when...

Various types of obstruction can occur after a gastrectomy for gastric cancer. If proper treatment is not performed, such obstructions can lead to serious conditions. Early postoperative Roux limb torsion is a rare complication, and few reports of endoscopic treatment for this complication have been made. In the present report, we describe the endoscopic detorsion of Roux limb torsion in two patients. The first case was a 77-year-old woman who underwent a laparoscopic distal gastrectomy with Roux-en-Y (R-Y) reconstruction for early gastric cancer and a laparoscopic ileocecal resection (ICR) for early colorectal cancer. On the 12th day after the gastrectomy, a Roux limb torsion was observed. Endoscopic detorsion was performed, and the patient recovered. She was discharged on postoperative day 40. The second case was a 73-year-old man who underwent a laparoscopic-assisted total gastrectomy with a R-Y reconstruction for early gastric cancer. On the 8th day after the gastrectomy, a Roux limb torsion occurred at the Y-shaped anastomosis (Y-anastomosis). Endoscopic detorsion was performed, and the patient recovered. He was discharged on postoperative day 17. In summary, we experienced two cases in which an endoscopic reduction of a Roux limb torsion was performed at the Y-anastomosis after gastrectomy with R-Y reconstruction. This study presents a further review of these cases and a summary of the existing literature.

Adnexal torsion is a rare complication estimated to occur in approximately 1/1000 pregnancies and considered as a surgical emergency. The clinical diagnosis remains difficult given the non-specificity of the clinical picture. Since the functional cysts during pregnancy often resolve spontaneously, the surgeon may opt for conservative management by de-torsion by laparoscopy. The adverse infant-related outcomes, even weakly described over the years, impose considerable harmlessness with respect to progressive pregnancy. In this report, we will describe the management of a torsion of an ovarian cyst in 11 weeks of pregnancy, and show that detorsion should be the procedure of choice for cases of simple ovarian torsion.

Ovarian torsion is a gynecological emergency generally affecting women of reproductive age, and urgent surgicalintervention is required to preserve ovarian function. Recurrent ipsilateral ovarian torsion is rarely seen but may causea severe decrease in reproductive capacity. Different surgical techniques have been described to prevent this. The casepresented here is of a 26-year old female with recurrent ipsilateral ovarian torsion, complicated by an ovarian rupture inthe third episode of torsion.

Clinical signs of liver lobe torsion in rabbits are often nonspecific and mimic those that are also generally detected with gastrointestinal stasis. Nonspecific clinical signs may result in pursuit of full-body imaging such as computed tomography (CT). The aim of this multicenter, retrospective, case series study was to describe CT findings of liver lobe torsion in a group of rabbits. Computed tomography studies of six rabbits with confirmed liver lobe torsion by surgery or necropsy were evaluated. The caudate liver lobe was affected in six out of six rabbits and was enlarged, rounded, hypoattenuating, heterogeneous, and minimally to noncontrast enhancing, with scant regional peritoneal effusion. Precontrast, mean Hounsfield units (HU) of the torsed liver lobe (39.3 HU [range, 24.4-48.1 HU]) were lower than mean HU of normal liver (55.1 HU [range, 49.6-60.8 HU]), with a mean torsed:normal HU ratio of 0.71 (range, 0.49-0.91). Postcontrast, mean HU of the torsed liver lobe (38.4 HU [range, 19.7-48.9 HU]) were also lower than mean HU of normal liver (108.4 HU [range, 84.5-142.0 HU]), with a lower postcontrast mean torsed:normal HU ratio of 0.35 (range, 0.14-0.48) compared to precontrast. Mean HU of torsed liver lobes had little difference pre- and postcontrast (postcontrast HU 1.0 times the average precontrast HU [range, 0.81-1.1]), and contrast enhancement of the torsed liver lobes was on average 50% lower than in normal liver. Liver lobe torsion should be considered in rabbits with an enlarged, hypoattenuating, heterogeneous, minimally to noncontrast enhancing liver lobe, particularly the caudate lobe, and scant regional peritoneal effusion.

Acute scrotum is a common clinical problem in children and torsion event superimposed on complete dissociation of the testicle and epididymis can be difficult to diagnose and often requires scrotal exploration. To the best of our knowledge, four cases of isolated torsion of the epididymis have been reported in the literature. We report a 17-year-old male patient with epididymal torsion who presented with testicular pain and hemi-scrotum swelling. Due to painful symptoms, emergency scrotal surgery exploration of the patient revealed a complete epididymis infarction due to isolated epididymal torsion with dissociation of the testis and epididymis.

Intussusception is the invagination of one segment of the intestine into the part of the tract that either precedes or follows in the gastrointestinal tract of different species of animals. This report describes a case of fatal multiple intestinal intussusceptions and torsion associated with non-degradable foreign body gastrointestinal obstruction in a captive lion (Panthera leo) in a zoo in Nigeria. Parenchymatous tissues were aseptically collected during necropsy for bacteriological isolation and histopathology. Also, intestinal fecal material was collected and sent for parasitological examination. The main lesions were gastroduodenal, duodeduodenal, duodejejunal and jejunojenunal intussusceptions and duodenal torsion. A non-degradable towel-like fabric foreign body obstruction along the pyloric antrum/canal region of the stomach down to the jejunum was found. Microscopic lesion included ischemic necrosis of inner circular and outer longitudinal smooth muscles of the intestine with necrosis of other layers and vascular congestion. Parasitological examination revealed presence of Babesia spp. in blood smear examined before the death of the lion. While Escherichia coli was isolated from the liver on MacConkey agar. A diagnosis of intussusception and torsion associated with non-degradable foreign body (fabric) gastrointestinal obstruction was made. This first case of ingestion of a non-degradable fabric foreign body leading to gastrointestinal obstruction in captive lion in Nigeria has brought about the need for vigilance of zoo authority to prevent a recurrence during crowd influx to the garden.

Intradural schwannoma accompanied with torsion is rare. Intradural lumbar schwannoma was found in a 63-year-old man presenting with right sacral pain radiating to the lower extremity. This mass showed minimal enhancement on MRI. The tumor's location changed each time on MRI and CT-myelography. The patient underwent surgical resection and the cauda equina, linked to this schwannoma, was severely twisted.

A dilatação vólvulo gástrica se instala quando o estômago se enche excessivamente de gás ocasionando uma dilatação, e consequentemente uma rotação do estômago sobre seu eixo mesentérico. A causa desta síndrome é desconhecida, mas exercícios após volumosas refeições favorece a ocorrência desta patologia. Por consequência da distensão seguida de torção gástrica, o estômago comprime a veia cava caudal e veia porta, acarretando em inúmeros distúrbios da circulação que prejudicam diretamente o sistema cardiorrespiratório. Diante deste e de outros fatores a alta taxa de mortalidade é uma realidade, portanto quanto antes o paciente for hospitalizado e diagnosticado, terá mais chances de sobreviver. O tratamento consiste primeiramente em estabilizar o paciente para depois seguir as metas da intervenção cirúrgico.

Fetal imagers are tasked with diagnosing complex fetal anomalies, but maternal abnormalities that may impact the pregnancy are also of utmost importance to recognize and report. Two rare obstetrical complications are uterine incarceration and torsion which can lead to increased maternal/perinatal mortality. Uterine incarceration occurs secondary to a retroverted uterus that becomes retroflexed and entrapped within the pelvis during the first trimester of pregnancy. Uterine torsion is rotation of more than 45° around its long axis. We report a rare case of an incarcerated uterus with presumed spontaneous resolution on follow-up MRI that was ultimately recognized to be uterine torsion at the time of delivery. Knowledge of these entities may help aid in timely detection and diagnosis of complex imaging presentations and avoid downstream complications.

A 68-year-old man visited a physician with a chief complaint of difficulty breathing. Right pleural effusion was noted, and he was referred to our department for a close examination and treatment. Thoracoscopy was performed under local anesthesia, and pleural dissemination of lung adenocarcinoma was noted, so a chest drain was placed. Since poor right lung inflation persisted and whole right lung torsion was observed on computed tomography, thoracoscopy-assisted thoracotomic reduction of lung torsion was performed. In this patient, the right middle lobe and anterior chest wall were adhered, suggesting that whole right lung torsion occurred when atelectasis was formed due to pleural effusion.

Isolated epididymal torsion is a very rare cause of an acute scrotum. Anomalies of the epididymis are more commonly encountered with undescended testicles and can predispose to epididymal torsion. Management is similar to that of testicular torsion. We report the case of a 3-year-old boy who presented with an acute scrotum. Immediate surgical exploration revealed an isolated epididymal torsion in an undescended testis, only the second of its kind to be reported so far. The epididymis and testis were salvaged and the testis was fixed in the scrotum. There are multiple learning points from this case report. Firstly, that epididymal torsion is a diagnosis to be considered when exploring an acute scrotum. Secondly, that epididymal torsion even an undescended testis can result in clinical symptoms of an acute scrotum. And finally, that epididymal anomalies encountered during surgery should be tackled appropriately, to prevent retorsion.

The aim of the study was to report the elevated liver function test levels in torsion of ovarian mature cystic teratoma (MCT). A retrospective review was performed of 116 patients with MCT who underwent surgery in our hospital between 2010 and 2017. Eleven of 116 patients were with torsion of MCT. Of the 11 torsion of MCT cases, 6 of those showed abnormal elevated levels of aspartate transaminase (AST)/alanine aminotransferase (ALT). After operation, AST/ALT levels recovered to normal ranges. Elevated liver function levels require attention to complications associated with anaesthesia and emergency operation. However, the current report shows that emergency surgery should not be delayed to assess other causes of elevated liver function tests.Impact statement

The adnexal masses in pregnancy range from 2% to 10%; the adnexal torsion is a rare cause of acute abdomen during pregnancy. Surgical management traditionally involved adnexectomy without detorsion of the compromised structure; recently conservative surgery was proposed which consists in detorsion and conservation of the affected annex. Objective: to describe the value of ultrasound guided fine needle puncture and aspiration as the initially treatment in pedicle torsion of adnexal cyst during pregnancy. Methods: prospective observational study of 9 patients that had the diagnosis of pedicle torsion of adnexal cyst during pregnancy who underwent ultrasound guided fine needle aspiration as a treatment of the adnexal cyst torsion between 2014 and 2019. Results: in all cases it was possible to save the compromised structure; in two cases we observed recurrence of the cyst, that was subsequently removed during a caesarean section in both cases; in the rest of the patient’s resolution was complete. Spontaneous abortion was seen in one of the patients, this event was not related to the invasive procedure. Conclusion: ultrasound guided fine needle aspiration of an adnexal who has suffered of pedicle torsion seems to be a good alternative for the management of this acute condition.

Objective To describe 4 Great Danes with colonic torsions and describe the risk of torsion recurrence in this breed, which has not previously been reported. This study also describes pneumocolon as a rapid and noninvasive diagnostic for confirmation of colonic torsion. Series summary Four Great Danes were presented with nonspecific gastrointestinal (GI) clinical signs. Colonic torsion was diagnosed in each case with either plain radiography identifying pneumocolon or contrast radiography (barium enema). Bloodwork in each case revealed nonspecific changes. Each case had a previous gastropexy, 3 of which were prophylactic and 1 as a surgical emergency for gastric dilatation-volvulus. Three cases had favorable outcomes with emergency surgical intervention and returned to normal activity levels with resolution of clinical signs. Two cases of colonic torsion recurred, 1 of which occurred subsequent to a prior left-sided colopexy. One case of recurrence had persistent clinical signs following surgical revision and was euthanized. New or unique information provided This is the first report describing pneumocolon to identify a colonic torsion, providing a rapid and low-morbidity diagnostic aid and to describe the recurrence of colonic torsion in 2 dogs. Support to a previous hypothesis for an association between colonic torsion and altered GI motility is provided. Prior publications reporting colonic torsion and entrapment in German Shepherd Dogs associated with disruption of the duodenocolic ligament reported no recurrence following correction without colopexy. The recurrence in these 2 dogs suggests colonic torsion in Great Danes may represent a different or more severe form of this condition.

Objective To investigate and compare the risks vs benefits of synchronous contralateral scrotal compartment exploration when testicular appendage torsion is diagnosed intra-operatively. Methods Emergency scrotal explorations performed at the Women's and Children's Hospital between 2002 and 2017 were retrospectively analysed to identify patients with testicular appendage torsion. Primary outcome measures were metachronous acute scrotum re-presentations and returns to theatre. Outcomes were compared between groups that underwent unilateral and bilateral scrotal compartment exploration. Results Testicular appendage torsion was diagnosed intra-operatively in 575 patients and 90.4% underwent unilateral scrotal exploration. Re-presentations with metachronous acute scrotum on the non-index side occurred in 8.5% of unexplored and 3.6% of previously explored sides (P = .29). Non-index side returns to theatre occurred in 5.4% of unexplored and 0% previously explored sides (P = .097). Future metachronous contralateral testicular appendage torsion was diagnosed in 4.2%. Post-operative complications were comparably low in both groups. The number needed to treat to prevent a return to theatre for metachronous contralateral testicular appendage torsion is 24. Conclusion The low morbidity of exploring the contralateral side is justifiable, but confers only limited benefit of preventing low likelihood future metachronous contralateral pathology. In balancing these risks, we recommend contralateral exploration as advisable but not a necessity.

Transposition of internal organs (situs inversus viscerum) is a rare version of biologically normal anatomy, in which the main internal organs have a mirror (reverse) arrangement compared to the normal position. Diseases of epiploic appendage (torsion, inflammation, necrosis) are rare and make up 0.1-0.3 % of acute diseases of the abdominal organs. A clinical case of treating a patient with acute appendicitis in combination with torsion and necrosis of epiploic appendage in the transposition of internal organs is presented.

Lung lobe torsion is one of the causes of dyspnea and respiratory changes in dogs. Twisting of the bronchovascular hilum on its axis, leads to loss of function and metabolic and physiological changes that result in necrosis of the affected lobe. Atelectasis, venous congestion, and pleural effusion secondary to the lobe torsion are responsible for the clinical signs. Chest radiographs or CT scan are used to confirm the diagnosis. In rare cases confirmation is done by exploratory thoracotomy. The prognosis is good after removal of the affected lung lobe. We report a case of left cranial lung lobe torsion in a 17-year-old bitch, successfully treated by lung lobectomy.

Warfarin toxicity presenting as acute abdomen in a woman with chronic anticoagulation is rare. A 29 year old woman with Rheumatic heart disease with history of mitral Valve replacement who was on anticoagulation with warfarin presented with pain abdomen of 2 weeks duration and she was clinically diagnosed as torsion ovarian cyst. On USG abdomen there was a complex adnexal mass of 6x8 cms with Doppler flow. Her International Normalised Ratio was more than 10 and hence a diagnosis of Ovarian haematoma was entertained and she was managed medically with dose titration of anticoagulants and her pain abdomen subsided and she was discharged home after normalising her International normalised ratio and laparotomy was thus avoided.

Background: Myocardial infarction is an acute emergency which needs rapid assessment, especially for myocardial reperfusion. Aim of the work: To evaluate left ventricle [LV] twist/torsion for assessment of myocardial reperfusion after acute ST-elevation myocardial infarction [STEMI] and to explore its relationship with LV function after 3 months. Patients and Methods:Forty-five patients with acute STEMI [30 anterior and 15 inferior] with a single culprit lesion were analyzed against 50 healthy subjects. Apical and basal rotations and LV twist/torsion were measured by two-dimensional speckle tracking imaging. Results: LV twist [13.5±2.4 vs 20±0.5] and LV torsion [1.8±0.2 vs 2.9±0.1, P=0.001] were reduced in all STEMI patients. Basal rotation was larger in anterior STEMI than in inferior STEMI and control [-8.09±0.7 vs -3.1±1.03 -6.2±0.6 successively], while apical rotation was significantly lower in anterior STEMI. LV twist and torsion were lower in anterior vs inferior STEMI [11.9±1.1 vs 16.6±1 and 1.7±0.1 vs 2.1±0.1, P=0.001 respectively]. There was moderate positive correlation between baseline LV torsion and LV ejection fraction at 3 months [r=0.500, P=0.001], while negative moderate correlation between baseline LV torsion and LV volumes [LV end-diastolic volume & LV end-systolic volume] [r=-0.444 & r=-0.479 respectively] was reported. Post reperfusion, the best cut-off point of LV torsion predicting LV remodeling was 1.9 with sensitivity 81.3% and specificity 82.8% [AUC =0.85]. Conclusion: Global LV torsion was decreased in acute STEMI patients, soon after reperfusion it showed marked improvement in LV torsion/twist. LV torsion early after reperfusion can predict LV remodeling at 3 months follow up.