surgery

1. .

2. VOLVULUS
Alam Zeb Amir
Roll no : 09

3. 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.

4. Presentation
History:
Abdominal pain,
distension, no flatus or
bowel movements
Examination:
Distension of abdomen,
mild tenderness,
palpable mass

5. TYPES OF VOLVULUS
MIDGUT
VOLVULUS
CECAL
VOLVULUS
SIGMOID
VOLVULUS

6. GASTRIC VOLVULUS

7. CAUSES
PREDISPOSING FACTORS
 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
 Chronic constipation

8. CLINICAL FEATURES
 Abdominal distension
 vomiting
 Ischemia (Necrosis)
 Absolute constipation
 Features of peritonitis
 Severe pain and progressive injury to the
intestinal wall
 Accumulation of gas and fluid

9. DIAGNOSTIC INVESTIGATIONS
 Laboratory investigations
1. FBC ( WBC)
2. Urea & Electrolytes
 Plain radiography
 Contrast studies
 Other imaging studies
1. Ultrasound
2. CT Scan

10. X-RAY

11. Barium Enema

12. TREATMENT
 Sigmoidoscopy (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

13. PRE-OPERATIVE
 Procedure and relief of psychological
stress
 Low residue diet
 Antibiotic e.g neomycin, streptomycin, etc
 Nasogastric or intestinal tube

14. POST OPERATIVE
 Until peristalsis return, anything to be given is
introduced parenteral
 Catheterize
 Analgesics
 Manage rectal tube sutured in the anus to
facilitate the passage of stool
 Neostigmine

15. COMPLICATIONS
•Intestinal perforation
•Dehydration
•Peritonitis
•Sepsis
•Ischemic bowel disease
•Death