Volvulus

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Volvulus

  1. 1. VOLVULUS
  2. 2. DEFINITIONVolvulus is a twisting of theintestine at least 180 degreeson its mesentery, whichresults in blood vesselcompression and ischemia.
  3. 3. TYPE MIDGUT CECAL SIGMOIDVOLVULUS VOLVULUS VOLVULUS
  4. 4. CAUSE1. Chronic constipation ( type of Constipation ).2. Abnormal intestinal contents (e.g. meconium ileus) or adhesions.3.Congenital intestinal malrotation.(failure
  5. 5. RISK FACTOR Paralytic ileus MegacolonHirschsprung’s disease
  6. 6. SIGN AND SYMPTOM1.May present as abdominal emergency-Acute distension-Colicky pain (spasm)-Failure to pass flatus or stool (constipation is prevailing feature)-Vomiting is late sign2.Rapid heart rate.3.Rapid breathing.
  7. 7. PATHOPHYSIOLOGY• Redundant sigmoid colon that has a narrow mesenteric attachment to posterior abdominal wall allows close approximation of 2 limbs of sigmoid colon à
  8. 8. DIAGNOSTIC TEST1. X-r ays — A bdom nal X-r ays m show i ayobst r uct i on and abnor m ai r -f l ui d l evel s al oi ,i i n t he si gm d and cecum n m dgut i vol vul us, abdom nal X-r ays m be i aynor m . al2. W t e bl ood cel l count — In strangulation, the hi count is greater than 15,000/µl, in bowel infarction, greater than 20,000/µl.
  9. 9. CON’T…3.B i umenem — I n cecal vol vul us, ar a bar i umf i l l s t he col on di st al t o t he sect i on of cecum .4.C put ed t om aphy scan — m show om ogr ay evi dence of i nt est i nal obst r uct i on.
  10. 10. X-RAY SHOWN
  11. 11. TREATMENT1.For children with midgut volvulus, surgery is required.2. For adults with sigmoid volvulus, nonsurgical treatment includes proctoscopy to check for infarction and reduction by careful insertion of a flexible sigmoidoscope to deflate the
  12. 12. TREATMENT3.Untwisting by performing sigmoidoscopy and placing rectal tube, monitor for signs of bowel ischemia for 2-3 days, if no improvement, consult surgery for laparotomy (sigmoid resection and primary anastamosis)
  13. 13. COMPLICATION1.Dehydration2.Ischemic bowel disease3.Intestinal perforation4.Peritonitis5.Sepsis

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