volvulus by alam zeb amir
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VOLVULUS Alam Zeb Amir
Roll no : 09
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VOLVULUS
It is the term applied to abnormal twisting of a loop of bowel so that the mesenteric vessel and the lumen of the bowel become occluded.
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PresentationHistory: Abdominal pain, distension, no flatus or bowel movementsExamination: Distension of abdomen, mild tenderness, palpable mass
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TYPES OF VOLVULUS
MIDGUT VOLVULUS
CECAL VOLVULUS
SIGMOID VOLVULU
S
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GASTRIC VOLVULUS
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CAUSESPREDISPOSING FACTORSOne with a normal anatomic variation
resulting in extra colonic loopsPatients with muscular dystrophy due to
the smooth muscle dysfunctionCongenital intestinal malrotationAbnormal intestinal contents e.g.
meconium ileus or adhesionsChronic constipation
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CLINICAL FEATURESAbdominal distensionvomiting Ischemia (Necrosis)Absolute constipationFeatures of peritonitisSevere pain and progressive injury to the
intestinal wallAccumulation of gas and fluid
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DIAGNOSTIC INVESTIGATIONS
Laboratory investigations1. FBC ( WBC)
2. Urea & Electrolytes Plain radiographyContrast studiesOther imaging studies 1. Ultrasound
2. CT Scan
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X-RAY
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Barium Enema
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TREATMENTSigmoidoscopy (sigmoidoscopic
reduction) intervention done by untwisting the gut
Laparotomy can be done to have a sigmoid resection or untwisting
Incision into the abdomen to untwist the knot (volvulus) and possibly resecting any unsalvageable portion
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PRE-OPERATIVEProcedure and relief of psychological
stressLow residue dietAntibiotic e.g neomycin, streptomycin,
etcNasogastric or intestinal tube
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POST OPERATIVEUntil peristalsis return, anything to be given is
introduced parenteralCatheterizeAnalgesicsManage rectal tube sutured in the anus to
facilitate the passage of stoolNeostigmine
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COMPLICATIONS•Intestinal perforation•Dehydration•Peritonitis•Sepsis•Ischemic bowel disease•Death
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