Tortous colon - Diverticulosis. Diverticulosis is the term used to describe the presence of diverticula — pouch-like structures that sometimes form in the muscular wall of the colon and bulge outward. Between 40% and 60% of people have them, and they get more common as we age. They tend to cluster in the sigmoid colon, just above the rectum.

 
My colon was VERY long, loopy and tortuous as previously discovered. During the UN-SEDATED colonic manometry procedure they had the same trouble the doctors in the past had with my colonoscopy. To the point they had to do it twice and it hurt like hell! There was still some contraction going on in my colon when given a small meal and when given .... Harvard admissions decision date 2023

This article describes the symptoms, cause, and diagnosis of tortuous colon as well as the various treatment options. It also explains how tortuous colon differs from irritable bowel syndrome (IBS), a gastrointestinal disorder with many of the same symptoms.67 Endoscopic decompression of the colon entails use of a scope to advance slowly through the volvulized part of the colon, using minimal insufflation to detorse the colon, restoring blood supply. The point of torsion may appear as a spiral or sphincter. Once the torsion has been passed, there is a release of fluid and gas with dilated bowel ...67 Endoscopic decompression of the colon entails use of a scope to advance slowly through the volvulized part of the colon, using minimal insufflation to detorse the colon, restoring blood supply. The point of torsion may appear as a spiral or sphincter. Once the torsion has been passed, there is a release of fluid and gas with dilated bowel ...Mar 15, 2024 ... The most common form of twisted bowel is sigmoid volvulus. It's the twisting of the last part of your colon, called the sigmoid colon. It can ...May 5, 2023 · Common symptoms of volvulus that may signal bowel obstruction include: Abdominal distention. Abdominal tenderness. Vomiting. Blood in stools. Constipation. Constipation and the inability to pass gas may occur together, leading to abdominal distention and possibly nausea and vomiting. Twisted bowel is a serious condition that needs prompt care. Learn about surgical and nonsurgical options to treat it. She usually moves her bowel one to two times a week with recent worsening to once every 10-20 days. Her menstrual cycles were regular. She was worked up in the past for constipation with endoscopy (EGD) which showed mild gastritis (Helicobacter pylori negative) and colonoscopy which showed tortuous and redundant colon and lot of stool. Symptoms of a twisted colon are crampy abdominal pain and swelling, sometimes with nausea and vomiting. X-rays of the affected area will show the cecum to be out of place and full of trapped air. A CT scan may reveal how tightly the volvulus is twisted. Sometimes, the problem can be reversed via a colonoscopy, but if blood supply is cut off, a ... A redundant or tortuous colon is a congenital condition that affects the digestive system. It can cause constipation, abdominal pain, and complications such as sigmoid …Aug 22, 2012 ... The female colon is therefore more likely to be acutely angulated and tortuous. ... tortuous sigmoid colon and open the lumen. Leung et al.16 ...Colonic volvulus is a loop of bowel twisted around the site of mesenteric attachment leading to bowel obstruction. The sigmoid colon is involved in a majority of these cases. If untreated, sigmoid volvulus leads to bowel ischemia, perforation, sepsis, and potential death.The fiber, a type of carb your body does not digest, is what makes these foods hard on someone with an inflamed colon. In addition to raw veggies and fruits, stay away from cooked kale, peas, winter squash, broccoli, Brussels sprouts, cabbage, onions and corn. Pineapple, figs, berries and certain dried fruit should be avoided.The colon is a 4 1/2-foot-long tube that constitutes the final portion of the intestinal tract. The food you eat is mostly digested in the stomach and small intestine. Residual material enters the colon, or large intestine, in the cecum, which lies in the right lower portion of the abdomen (see Figure 1). From there, digested material travels ...Inflammation from conditions, such as inflammatory bowel disease, that cause your colon to narrow; A naturally extra-long colon; Tortuous colon, a condition where your colon has extra loops and turns; Diverticular disease, a set of conditions involving small pockets in the wall of your colon; Polyps that are difficult to remove with standard ...The colon’s regular biological measurement is 47-60 inches in length. Suppose this length is exaggerated due to any cause. In that case, you will have an elongated colon that will start overlapping side-by-side or increase in tortuosity to accommodate the smaller space in your abdominal cavity. Hence the name tortuous …Colonic volvulus occurs when the colon twists around the tissue that holds it in place, called mesentery. The twisting causes intestinal obstruction. The most common types of colonic volvulus are. sigmoid volvulus, which is twisting of the sigmoid colon. cecal volvulus, which is twisting of the cecum and ascending colon.The images recreate the colon and reveal polyps as small as 1 centimeter with 90-95% accuracy. The CT colonography is an alternative to a colonoscopy for people who: - Had an incomplete colonoscopy. - A tortuous colon — one that’s longer than normal, resulting in a lot of loops. - On blood thinners or anti-coagulants because of heart issues.Mar 29, 2014 ... In patients with incomplete colonoscopy, cecal intubation is sometimes unsuccessful due to a redundant or tortuous colon.HowStuffWorks looks at Elon Musk's plan for humans heading to Mars sooner rather than later. Advertisement Elon Musk, the founder and CEO of SpaceX, has written his own version of ...The images recreate the colon and reveal polyps as small as 1 centimeter with 90-95% accuracy. The CT colonography is an alternative to a colonoscopy for people who: - Had an incomplete colonoscopy. - A tortuous colon — one that’s longer than normal, resulting in a lot of loops. - On blood thinners or anti-coagulants because of heart issues.The ascending colon, or the second part of the colon, starting at the cecum; The transverse colon, located across the abdomen, is the longest and most movable part of the colon. It connects to the descending colon at the splenic flexure. The descending colon, or the part of the colon that stores stool before it reaches the sigmoid colonKey points. Blind loop syndrome occurs when food doesn't follow the normal digestion route and bypasses a section of your intestine. It can be caused by abdominal surgery, diverticulitis, inflammatory bowel disease, peptic ulcer disease, or an infection. One of the main symptoms of blind loop syndrome is unexplained weight loss.She usually moves her bowel one to two times a week with recent worsening to once every 10-20 days. Her menstrual cycles were regular. She was worked up in the past for constipation with endoscopy (EGD) which showed mild gastritis (Helicobacter pylori negative) and colonoscopy which showed tortuous and redundant colon and lot of stool.Dr. Philip Woodworth answered. General Surgery 27 years experience. Yes: If unable to remove the lesion endoscopically you need to have it surgically removed as colon polyps are believed to progress into colon cancers. Created for people with ongoing healthcare needs but benefits everyone. Learn how we can help.Colon volvulus is an abnormal twisting within the gastrointestinal tract that can impair blood flow. Most cases occur in the sigmoid colon, the S-shaped last part of the large intestine that leads to the rectum. When the twisting happens here, it is called sigmoid volvulus. Less frequently, the twisting occurs in the cecum, which is the pouch ...Redundant/Tortuous Colon & Severe Constipation. Posted by kjn72 @kjn72, Nov 8, 2022. JN: I am a 72y/o woman with severe constipation & a redundant colon. 7 years ago I had 14" of colon removed and 3 additional surgeries for a rectocele, entrocele and another bowel prolapse. I have been severely constipated before and after surgeries.Customer: Have abnormal pain for 2 months begin to doctors had cologhospy and pain is still there have a tortous colon. Still have the pain. Doctor's Assistant: How long have you had the pain? Have you used any medication for it? Customer: For about 2 months Been on antibiotics Doctor's Assistant: Have you used anything besides the antibiotics for this? ...A tortuous colon, also known as a redundant colon or elongated colon, is a condition where the colon becomes excessively long and twisted. This anatomical variation can make it challenging for doctors to thoroughly examine the colon using traditional diagnostic methods. However, colonoscopy is a valuable tool that overcomes …Redundant, tortous colon ladybo22. I just had a colonoscopy performed today and my results are that I have a redundant, tortous colon. I have no clue what this is. Unfortunately, I did not have anyone at the hospital with me and I don't remember speaking to the doctor, as I was just coming awake from sedation. Please help explain this to me.A tortuous colon isn't called that due to the pain it inflicts. In this instance, tortuous simply means "having bends and twists." While that's an apt description for all intestines, a tortuous colon, sometimes known as a redundant colon, simply means the colon is longer than usual. It only becomes a serious problem when the elongated colon ...The rate of colon perforations during colonoscopies reported in PA-PSRS (0.039-0.047%) is low compared to the rates reported in the literature. For example, the Mayo Clinic in Scottsdale, Arizona, reported a perforation rate of 0.19%;1 a university teaching hospital in Canada reported a rate of 0.13%;2 and the Lehigh Valley Hospital reported a ...Tortuous Colon a colon that is longer than a normal colon, with additional bends and twists. Congenital Diaphragmatic Hernia diaphragmatic hernia that is present at birth. Microcolon a rare congenital abnormality characterized by the presence of an abnormally small colon. it is the result of intestinal underutilization during fetal development.The gastroenterologist was unable to complete a regular colonsocsopy due to possible adhesions or diverticulitis in sigmoid colon at the first turn. Thank you. This discussion is related to tortuous colon. I was diagnosed with torturous bowel several years ago, and currently take Dicyclomine 3x per day and Linzess (as needed) to control the ...Anyone can get colon polyps, and you might not even know when you have them. For those that have colon polyps, it’s important to diagnose them early before they lead to more seriou...Due to the transverse colon revealed significantly excessive looping and a redundant colon the procedure was aborted. Having a redundant torturous colon causes problems with a colonoscopy. One of the risks is perforated bowel. Yes, it has caused a few problems for me every time they do my Colonoscopy.Twist of colon or intestine. Excludes2: volvulus of duodenum . K56. Excludes1: congenital stricture or stenosis of intestine (Q41-Q42) cystic fibrosis with meconium ileus ischemic stricture of intestine meconium ileus NOS neonatal intestinal obstructions classifiable to P76.- obstruction of ...Indeed, this was the highly-anticipated debut of MLB's top prospect Paul Skenes and Pirates fans were flocking to the ballpark to witness what could be a turning point for …Overview. Doctors have several options for treating a bowel obstruction caused by twisting of the intestine (volvulus). The choice of procedure depends on the location of the obstruction. If the obstruction is caused by a twisting of the sigmoid area of the large intestine, a doctor may try to straighten out the twisting segment with lighted …Cecal volvulus is twisting of the cecum and ascending colon. Normally, the cecum and ascending colon are fixed to the abdominal wall. If improperly attached, they can move and become twisted. Symptoms of Cecal Volvulus. More commonly seen in people ages 30 to 60, cecal volvulus may be caused by abdominal adhesions, severe coughing, or …Tortuous Colon Constipation Help. rosesanlilacs. I just was diagnosed with a tortuous colon after months of agony from constipation and a lifetime of general gastrointestinal issues. I'm only 31 and would prefer not to have surgery...I heard it is very risky and last resort only. I've been told to take Colace and Miralax.fied by reason for prior incomplete colonoscopy: tortuous/an- gulated colon (“tortuous”), redundant colon due to looping. (“looping”), or “both.” P values of ...Tortuous colon is used to describe the condition when large intestine becomes longer than the usual. For adjusting in the allocated space in the abdomen, tortuous colon becomes more twisted. In this condition, the loops and bends in the colon is more and it looks like a tortuous. Sometimes too much bending or twisting obstructs the intestinal ...A tortuous colon is a condition where the colon has an irregular shape, characterized by twists and turns instead of a straight path. This abnormality can be present from birth or develop over time due to factors such as age, genetics, or certain medical conditions. While the exact cause of tortuous colon remains unknown, it is believed to …Elongated (called redundant) colon often occurs in patients with constipation. These patients are notable during colonic endoscopy because it is very hard to get along the length of the colon (Rex et al. 2007).Both colonic transit time and constipation symptoms increase with the number of redundancies and these are the patients that are …Diverticulosis. Diverticulosis is the term used to describe the presence of diverticula — pouch-like structures that sometimes form in the muscular wall of the colon and bulge outward. Between 40% and 60% of people have them, and they get more common as we age. They tend to cluster in the sigmoid colon, just above the rectum.Irritable bowel syndrome (IBS) is a disorder that affects your large intestine or colon. When you have IBS your colon looks normal. But it does not work the ...Redundant colon, sometimes referred to as tortuous colon, is a term used to describe when someone has a colon that's longer than normal. In addition to the extra length, a …Colorectal cancer (also known as colon cancer) is the third most deadly type of cancer in the United States. There are over 50,000 deaths each year. But, when it is caught early, t...The gastroenterologist was unable to complete a regular colonsocsopy due to possible adhesions or diverticulitis in sigmoid colon at the first turn. Thank you. This discussion is related to tortuous colon. I was diagnosed with torturous bowel several years ago, and currently take Dicyclomine 3x per day and Linzess (as needed) to control the ...Volvulus (Twisting of the Colon) Volvulus occurs when the intestine twists around itself and the mesentery that supports it, creating an obstruction. The area of intestine above the obstruction continues to function and fills with food, fluid, and gas. The mesentery may become so tightly twisted that blood flow to the affected part of the ...Diverticulosis. Diverticulosis is the term used to describe the presence of diverticula — pouch-like structures that sometimes form in the muscular wall of the colon and bulge outward. Between 40% and 60% of people have them, and they get more common as we age. They tend to cluster in the sigmoid colon, just above the rectum.Jul 29, 2021 ... ... colon and how people can support their colon health. The function of ... Related Coverage. What to know about a Redundant or tortuous colon · A ... Inflammation from conditions, such as inflammatory bowel disease, that cause your colon to narrow; A naturally extra-long colon; Tortuous colon, a condition where your colon has extra loops and turns; Diverticular disease, a set of conditions involving small pockets in the wall of your colon; Polyps that are difficult to remove with standard ... 1 day ago · Symptoms of Twisting Bowel. The most common symptoms include dizziness, nausea, vomiting, unexplained swollen stomach, constipation, bloating, and difficulty making a bowel movement and blood stool. Skin near the twist may be distended and tender. Some patients also report shortness of breath, intense fatigue or backaches when suffering from it. A redundant colon is a longer colon with additional loops or twists. It can cause constipation, bloating, and complications like colonic volvulus or sigmoid volvulus. Learn about the symptoms, causes, treatments, and home care for a redundant colon from Healthline. Colon cancer symptoms include a change in bowel habits such as diarrhea or constipation as well as a change in the consistency of an individual’s stool, explains Mayo Clinic.The gastroenterologist was unable to complete a regular colonsocsopy due to possible adhesions or diverticulitis in sigmoid colon at the first turn. Thank you. This discussion is related to tortuous colon. I was diagnosed with torturous bowel several years ago, and currently take Dicyclomine 3x per day and Linzess (as needed) to control the ...The ICD code K562 is used to code Volvulus. The term volvulus has its roots from medieval Latin "volvere"; which means "to roll". Specialty: General Surgery. MeSH Codes: D045822, D045822. ICD 9 Codes: 537.3 , 560.2. Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock.Once the overtube has passed through a tortuous sigmoid colon or through the splenic flexure, suction is applied to allow the device to rigidize in any conformation. The colonoscope can then be advanced through the rigid overtube toward the cecum without forming a loop. In addition, endoscope exchanges may be performed through the …Irritable bowel syndrome (IBS) causes uncomfortable abdominal symptoms, including constipation, diarrhea, gas and bloating. Cecal volvulus is twisting of the cecum and ascending colon. Normally, the cecum and ascending colon are fixed to the abdominal wall. If improperly attached, they can move and become twisted. Symptoms of Cecal Volvulus. More commonly seen in people ages 30 to 60, cecal volvulus may be caused by abdominal adhesions, severe coughing, or pregnancy. Aug 17, 2023 ... Although often asymptomatic, an elongated colon can present symptoms ranging from constipation and bloating to abdominal pain and nausea.A colonic volvulus occurs when a part of the colon twists on its mesentery, resulting in acute, subacute, or chronic colonic obstruction. The main types of colonic volvulus are sigmoid volvulus and cecal volvulus. [ 1, 2] See Can't-Miss Gastrointestinal Diagnoses, a Critical Images slideshow, to help diagnose the potentially life-threatening ...Nov 13, 2022 · A serious stricture can block your bowels and make it hard for you to poop. Symptoms of a colon stricture may include if you: Are nauseated or feel sick to your stomach. Throw up. Have stomach ... Redundant colon (also known as elongated colon) is when the colon is abnormally long and has folds to fit into the abdominal cavity. Tortuous colon on the other hand is where the colon loops and twists to fit inside the body. These are congenital conditions (meaning you are born with them) and can be the resulting cause of people …May 5, 2023 · Common symptoms of volvulus that may signal bowel obstruction include: Abdominal distention. Abdominal tenderness. Vomiting. Blood in stools. Constipation. Constipation and the inability to pass gas may occur together, leading to abdominal distention and possibly nausea and vomiting. Sigmoid Colon: Function in the Large Intestine. The sigmoid colon is the section of the large intestine closest to the rectum and anus. It measures around 35 to 40 centimeters (around 1.5 feet) in length and is shaped like the letter "S." Its job is to hold fecal matter until you have a bowel movement.Air or barium enema. An air or barium enema allows for enhanced imaging of the colon. This may be done for certain suspected causes of obstruction. During the procedure, the …The tortuous colon, also known as redundant colon or elongated colon, is a condition in which the large intestine becomes longer and more twisted than usual. This can lead to a variety of symptoms and complications, and may require medical intervention to manage.For more information. Visit the Weiss Center, home of the largest institutional registry of patents with a dominantly inherited colon cancer syndrome in the United States, and the second largest in the world.; Visit the Center for Young-Onset Colorectal Cancer, which specializes in treating patients under age 50 with colorectal cancer.; Visit the …Ogilvie syndrome, also known as acute colonic pseudo-obstruction, is a type of intestinal pseudo-obstruction that affects your colon specifically. She usually moves her bowel one to two times a week with recent worsening to once every 10-20 days. Her menstrual cycles were regular. She was worked up in the past for constipation with endoscopy (EGD) which showed mild gastritis (Helicobacter pylori negative) and colonoscopy which showed tortuous and redundant colon and lot of stool. Sep 17, 2017 ... Learn how to say Tortuous with EmmaSaying free pronunciation tutorials. Definition and meaning can be found here: ...Nov 7, 2018 · A redundant colon is an abnormally long colon, especially in the final section (called descending colon). A redundant colon also has additional loops or twists. Other names for a redundant colon include tortuous colon or elongated colon. The tortuous colon, also known as a redundant colon, is an anatomical variation that affects the large intestine. It is characterized by an excessive length and an increased number of loops and turns compared to a normal colon. This elongated and convoluted structure can pose challenges to the digestive process and impact overall ...Nov 19, 2009 · Tortuous colon, redundant colon, looping colon is generally considered an anatomical variation and I've seen most coders refer to 751.5 for the diagnosis. M. Volvulus is a serious condition where part of the intestine twists around itself and cuts off blood supply. It can affect the cecal or sigmoid colon and cause pain, vomiting, …A tortuous colon is one that is longer than normal. In this relatively rare condition, the colon has extra twists and turns in order to fit in the abdomen. Colonoscopy: Overview. Colon Function . The majority of the nutrients you eat are absorbed in the small intestine well before the "food" reaches your colon.Irritable bowel syndrome (IBS) causes uncomfortable abdominal symptoms, including constipation, diarrhea, gas and bloating.A tortuous (or redundant, elongated) colon is a health condition that may or may not present symptoms to a patient. This issue results from the large intestine becoming longer than normal, causing the colon to twist and bend in order to adjust to its allocated space in the body.Typical reasons for colonization are to steal natural resources, expand territories and culturally dominate a group of people who are distinguishable by race and/or religion.A Redundant Colon or a 'Tortuous colon' is a congenital abnormality of the intestines such that the colon is longer than what is considered normal. Though not necessarily dangerous, it is usually diagnosed as a result of a colonoscopy and may make it a more difficult procedure.Colonic inertia is defined as the inability of the colon to modify stool to an acceptable consistency and move the stool from the cecum to the rectosigmoid area at least once every 3 days. 1 An orderly evaluation can confirm the diagnosis and ... It is also difficult to perform a colonoscopy on patients with redundant tortuous colons and ...

Tortuous colon; Professional guidelines. PubMed. AGA Clinical Practice Update on Endoscopic Management of Perforations in Gastrointestinal Tract: Expert Review. Lee JH, Kedia P, Stavropoulos SN, Carr-Locke D Clin Gastroenterol Hepatol 2021 Nov;19(11):2252-2261.e2. Epub 2021 Jul 2 doi: 10.1016/j.cgh.2021.06.045.. Golden cabinet herbal medicinary

tortous colon

My colon was VERY long, loopy and tortuous as previously discovered. During the UN-SEDATED colonic manometry procedure they had the same trouble the doctors in the past had with my colonoscopy. To the point they had to do it twice and it hurt like hell! There was still some contraction going on in my colon when given a small meal and when given ...By Admin • 10 Oct, 2022. Vitamin C is a powerful antioxidant with impressive benefits including immune enhancement, protection from viruses and bacteria, cardiovascular protection, eye diseases and even skin wrinkles. Here are some of the impressive health benefits. Science Based Wellness & Chiropractic in Ponte Vedra …Due to the transverse colon revealed significantly excessive looping and a redundant colon the procedure was aborted. Having a redundant torturous colon causes problems with a colonoscopy. One of the risks is perforated bowel. Yes, it has caused a few problems for me every time they do my Colonoscopy.Redundant, tortous colon ladybo22. I just had a colonoscopy performed today and my results are that I have a redundant, tortous colon. I have no clue what this is. Unfortunately, I did not have anyone at the hospital with me and I don't remember speaking to the doctor, as I was just coming awake from sedation. Please help explain this to me.Sigmoid Colon: Function in the Large Intestine. The sigmoid colon is the section of the large intestine closest to the rectum and anus. It measures around 35 to 40 centimeters (around 1.5 feet) in length and is shaped like the letter "S." Its job is to hold fecal matter until you have a bowel movement.Jun 25, 2014 · A tortuous colon does not need any treatment unless it causes abdominal discomfort such as cramps and pain, bloating etc. Simple dietary alterations in most cases alleviate the symptoms. Complications arise and prompt medical attention is needed when the elongated colon severely twists leading to intestinal obstruction. Hello everybody, I am 56 and have been suffering since my early 20s, I am so glad I can find others I can relate to. I share most of the symptoms described before, I have a redundant tortuous, colon, I am bloated and look 5 months pregnant, have hard dried stools and recently developed rectocele, etc) my life revolves around my GI tract.A tortuous colon isn't called that due to the pain it inflicts. In this instance, tortuous simply means "having bends and twists." While that's an apt description for all intestines, a tortuous colon, sometimes known as a redundant colon, simply means the colon is longer than usual. It only becomes a serious problem when the elongated colon ...Mar 29, 2014 ... In patients with incomplete colonoscopy, cecal intubation is sometimes unsuccessful due to a redundant or tortuous colon.A redundant or tortuous colon is a congenital condition that affects the digestive system. It can cause constipation, abdominal pain, and complications such as sigmoid …Vascular ectasias (angiodysplasias, arteriovenous malformations) are dilated, tortuous vessels that typically develop in the cecum and ascending colon. They occur mainly in people > age 60 and are the most common cause of lower gastrointestinal (GI) bleeding in that age group. They are thought to be degenerative and do not occur in association ...Hiwot Desta, M.D. | Colon, Stomach & Liver Center and The Loudoun Endoscopy Group. Hiwot Desta, MD is board certified in Gastroenterology. Dr. Desta has had numerous …Applicable To. Urinary tract obstruction due to specified cause; Code First, if applicable, any causal condition, such as: enlarged prostate ()Tortuous Colon Constipation Help. rosesanlilacs. I just was diagnosed with a tortuous colon after months of agony from constipation and a lifetime of general gastrointestinal issues. I'm only 31 and would prefer not to have surgery...I heard it is very risky and last resort only. I've been told to take Colace and Miralax.Aug 16, 2023 · The colon is the part of the large intestine that absorbs nutrients and water from undigested food and makes it into stool. Learn more about the colon. ... also called a tortuous colon, has ... Jan 26, 2022 ... "When a person has a tortuous colon, the additional length and looping can result in specific colonoscopy-related injuries or consequences.Colon volvulus is an abnormal twisting within the gastrointestinal tract that can impair blood flow. Most cases occur in the sigmoid colon, the S-shaped last part of the large intestine that leads to the rectum. When the twisting happens here, it is called sigmoid volvulus. Less frequently, the twisting occurs in the cecum, which is the pouch ...A redundant colon, sometimes referred to as an elongated or tortuous colon, is an anatomically long, floppy colon. Because of the length, it naturally twists, turns, and flips onto itself to fit into a comparatively small abdominal cavity. This can make colonoscopy quite challenging, as the advancing scope must maneuver through looped segments ...If the endoscopist should drive the colonoscope into a very tortuous colon with many angled segments, then a number of ancillary maneuvers should be adopted ....

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