volvulus by alam zeb amir
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VOLVULUS Alam Zeb Amir
Roll no : 09
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.
PresentationHistory: Abdominal pain, distension, no flatus or bowel movementsExamination: Distension of abdomen, mild tenderness, palpable mass
TYPES OF VOLVULUS
MIDGUT VOLVULUS
CECAL VOLVULUS
SIGMOID VOLVULU
S
GASTRIC VOLVULUS
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
CLINICAL FEATURESAbdominal distensionvomiting Ischemia (Necrosis)Absolute constipationFeatures of peritonitisSevere pain and progressive injury to the
intestinal wallAccumulation of gas and fluid
DIAGNOSTIC INVESTIGATIONS
Laboratory investigations1. FBC ( WBC)
2. Urea & Electrolytes Plain radiographyContrast studiesOther imaging studies 1. Ultrasound
2. CT Scan
X-RAY
Barium Enema
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
PRE-OPERATIVEProcedure and relief of psychological
stressLow residue dietAntibiotic e.g neomycin, streptomycin,
etcNasogastric or intestinal tube
POST OPERATIVEUntil peristalsis return, anything to be given is
introduced parenteralCatheterizeAnalgesicsManage rectal tube sutured in the anus to
facilitate the passage of stoolNeostigmine
COMPLICATIONS•Intestinal perforation•Dehydration•Peritonitis•Sepsis•Ischemic bowel disease•Death
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