3. OUTLINE CONTโ
๏ Treatment
๏ Pre-Operative Care
๏ Post Operative Care
๏ Complications
๏ Care plan (Nursing Diagnosis and
outcomes)
๏ References
4. VOLVULUS
It is the term applied to twisting
of a loop of bowel so that the
mesenteric vessel and the lumen
of the bowel become occluded. It
therefore is an obstruction of the
bowel.
5. Volvulus
๏ Obstruction caused by
twisting of the intestines more
than 180 degrees about the
axis of the mesentery
๏ 1-5% of large bowel
obstructions
โฆ Sigmoid ~ 65%
โฆ Cecum ~25%
โฆ Transverse colon ~4%
โฆ Splenic Flexure
6. TYPES OF VOLVULUS
๏ Volvulus neonatorum
๏ Volvulus of the small intestine
๏ Ceacal volvulus (volvulus of the caecum)
๏ Sigmoid volvulus (which is most common
and responsible for most intestinal
obstruction)
๏ Gastric volvulus
11. CAUSES
๏ No actual cause is known but certain
predisposing conditions which results or
complicates into volvulus will be
discussed in subsequent slides.
12. PREDISPOSING FACTORS
๏ Personโs with a redundant colon
๏ One with a normal anatomic variation
resulting in extra colonic loops
๏ Patients with muscular dystrophy due to
the smooth muscle dysfunction
๏ Congenital intestinal malrotation
๏ Abnormal intestinal contents e.g.
meconium ileus or adhesions
14. INCIDENCE
๏ Occurs commonly in middle aged and
elderly people especially in men.
15. PATHOPHYSIOLOGY
๏ The sigmoid colon twists upon itself
resulting in the intestinal obstruction
(vovulus) which could be:
๏ Acute (total vascular impairment)
๏ Sub-acute (without vascular impairment)
๏ Chronic (twisting occurs followed by a
correction but twisting reoccurs this time
to form a double knot known as
ileosigmoid knotting which involves the
sigmoid colon and ileum.
16. CLINICAL FEATURES
๏ Abdominal distension and vomiting
๏ Ischemia (loss of blood flow) to the
affected portion of intestine
๏ Absolute constipation
๏ There may be visible peristalsis as well as
features of peritonitis
๏ Severe pain and progressive injury to the
intestinal wall
17. CLINICAL FEATURES CONTโ
๏ Accumulation of gas and fluid in the
portion of the bowel
๏ Necrosis of the affected intestinal
18. DIAGNOSTIC INVESTIGATIONS
This includes:
๏ An Upper GI series (the use of barium
meal swallow to perform a GIT
radiography)
๏ A Digital rectal examination with rectal
tube
๏ And the taking of a straight x-ray film of
the abdomen
24. NURSING INTERVENTION
๏ Administer analgesics required to client to
ease off pain
๏ Encourage client to avoid copious foods
that will induce vomiting
๏ Give anti-emetics prescribed.
๏ IV fluid administration is done to replace
body fluids and prevent acidosis by
maintaining electrolyte balance.
26. TREATMENT
๏ This is a surgical intervention done by
untwisting the gut in a procedure called
sigmoidoscopy (sigmoidoscopic
reduction)
๏ Also 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
27. Operative management for
sigmoid volvulus
๏ Elective resection
โฆ Same admission
๏ Emergent laparotomy
โฆ Operation depends on
viability of the bowel
๏ Resection and anastomosis
๏ Hartmann resection
๏ Exteriorization resection
๏ Detorsion
๏ Detorsion with colopexy
๏ Percutaneous colostomy
๏ Percutaneous sigmoidpexy
28. PRE-OPERATIVE ACTIVITIES
๏ Explain procedure to client and relief of
psychological stress
๏ Skin preparations e.g. Shaving the abdomen
๏ Give patient a low residue diet to have less
stools formed
๏ Antibiotic administration 3-5 days before
surgery in an attempt to decrease the bacteria
of the bowel content with the aim of
decreasing wound infection. E.g. include
neomycin, streptomycin, etc
29. PRE-OPERATIVE ACTIVITIES
CONTโ
๏ A nasogastric or intestinal tube is inserted
before operation and connected to a
suction machine to clear the intestinal
contents.
30. POST OPERATIVE ACTIVITIES
๏ Until peristalsis return, anything to be
given is introduced parenteral
๏ Moisten mouth with clean water as a
result of dryness created by anaesthetic
agent
๏ All fluids given as infusions should be
recorded
๏ Catheterize patient to ease difficulty in
voiding and to prevent urine retention
31. POST OPERATIVE ACTIVITIES
CONTโ
๏ Give opiod analgesics to relieve pain
๏ Encourage patient to do deep breathing
and to change position every 1 hour
๏ Manage rectal tube sutured in the anus to
facilitate the passage of stool
๏ Drugs such as neostigmine is given to
prevent straining the intestine during
expulsion
๏ Early ambulation to start peristalsis
32. COMPLICATIONS
๏ A serious condition that could result in
death especially in the acute type of
volvulus.
33. NURSING DIAGNOSIS
๏ Pain in patient related to bowel
obstruction
๏ High risk for fluid volume deficit related
to fluid shifts and losses from vomiting.
๏ Fear and anxiety of patient and family
related to undergoing invasive procedures
34. EXPECTED OUTCOMES
๏ Pain will subside in 3-5 hrs as normal
peristaltic movements returns to normal
and allow oral intake of foods
๏ Patient will maintain a normal electrolyte
balance and skin turgor within 24 hrs.
๏ Fear and anxiety will be alleviated by
making client have the confidence and
conviction that all will be well.
35. REFERENCES
๏ Colmer. M.R. Moroneyโs Surgery for
Nurses, London: Churchil Livingston.
๏ Bloom. , A and Bloom, S.R. Tooheyโs
Medicine for Nurses, London: churchil
Livingstone
๏ Reynolds Watson, J.E., Watsonโs Medical-
Surgical Nursing and Related
Physiology, London: Baillierre Tindall.
Editor's Notes
Longitudinal axis extend from gastroesophageal junction to the pylorusThe stomach may rotate on a longitudinAal axis that extends from the gastroesophageal junction to the pylorus.Rotation about this axis causes the greater curvature of the stomach to rest superior to the lesser curvature, resulting in an โupside-downโ stomach. This is called โorganoaxialvolvulusโ.
Mesenteroaxial axis extends from greater to lesser curvature of stomachCauses complete obstructionRotation of the stomach along an axis perpendicular to its longitudinal axis is called โmesentero-axial volvulusโ
Rotation of the stomach about both the organoaxial and mesenteroaxial axes is termed โcombined volvulusโ.