sigmoid volvulus ppt

1. VOLVULUS
JLENGWE jr3

2. Introduction
• Obstruction caused by a loop in the intestines that twists and surrounds
messentery, attaches intestine to back wall of the abdomen
• volvulus is simply mean, intestines twist around its mesentery
• compound volvulus a.k.a ileosigmoid knotting:- twisting of the ileum and
sigmoid and viceversa. It is an intraoperative finding (difficult to see on x-ray).
it sometimes centrally located like that of small intestine volvulus

4. TYPES
1. Sigmoid volvulus- most common
2. Ceaecal volvulus- 2nd most common
3. Gastric volvulus
4. Midgut (small intestine)
• other way of classifying includes: Acute, Sub-acute and Compound

5. Risk factors
• Old age and middle age
• Constipation
• Hirsprungs disease (increases the risk)
• Pregnancy(fetus can cause displacement and twisting of the colon)
• Abdominal adhesion(the scar tissue creates attachment between two
parts of abdomen where the colon can twist)

6. History of presenting illness
• patient presents with features of intestinal obstruction
• colick abdominal pain
• abdominal distension
• absolute constipation
• vomiting (usually late sign due to sigmoid distally located)
• dehydration
• fever

7. Physical examination
• Distended abdomen
• Abdomen is often very tympanic to percussion
• If perforate or ischaemic: features of peritonism

8. Clinical investigation
LABORATORY
• Full blood count and differentials
• electrolytes and urea, creatinine
• liver function test
• erythrocyte sedementation rate(ESR)

9. IMAGING (diagnostics modalities)
• Abdominal x-ray (coffee bean/sigma sign, fridmandell’s sign,omega
sign)
- Erect x-ray - gases
- Supine x-ray - gas fluid levels
• Barium enema

11. • Ct scan (abdomen -pelvis with contrast)
- much more sensitive and specific for bowel obstruction
- identifies the site and cause
- classically demonstrate a very dilated sigmoid colon with a ‘whirl
sign’, from the twisting mesentery around its base

12. Differential diagnosis
• Severe constipation
• Pseudo-obstructions
• Severe sigmoid diverticular disease

13. Treatment
• Sigmoidoscopy and insertion of the flatus tube (to decompress and
devolvulate the sigmoid volvulus)
• Colonoscopy (to decompress and devolvulate the midgut)
• Surgery (indication for surgery- laparatomy for a hartmann’s procedure)
- colonic ischaemia or perforation
- repeated failed attempts of decompression
- necrotic bowel noted at endoscopy

14. Complications
• strangulation
• gangrene
• perforation
• hemorrhage
• dehydration
• shock
• electrolytes imbalances
• recurrence in cases where surgery was not done

15. JLENGWE jr3
TWALUMBA