Volvulus

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Volvulus

  1. 1. GIT volvulus Dr/ Hytham Nafady
  2. 2. Volvulus • Twist of the bowel around its own mesentery.
  3. 3. Volvulus (twist of the bowel around its own mesentery) Closed loop obstruction (obstruction of the bowel at 2 points in 1 location) Strangulation (obstruction of the bowel with interruption of its blood supply)
  4. 4. Closed loop obstruction
  5. 5. Volvulus Gastric volvulus Organo-axial Mesentero- axial Midgut volvulus Colonic volvulus Sigmoid Organo- axial Mesentero- axial Cecal Axial Bascule
  6. 6. Colonic volvulus
  7. 7. Causes of closed loop obstruction Closed loop obstruction Small bowel Hernia Adhesions Volvulus Large bowel Volvulus
  8. 8. Etiology
  9. 9. Etiology Gastric volvulus Midgut volvulus Sigmoid volvulus Cecal volvulus 1ry: Congenital weakness of suspensory ligaments. 2ry: Diaphragmatic hernia. Diaphragmatic eventration Malrotation (short mesenteric attachment). Congenital short mesentery. Chronic constipation. Colonic distention. Congenital defect in the peritoneal fixation of the right colon. Congenital long mesentery. Congenital malrotation. Chronic constipation. Colonic distension.
  10. 10. Gastric volvulus 1ry Congenital weakness of the suspensory ligaments Gastro- splenic Gastro- colic Gastro- hepatic Gastro- phrenic 2ry Diaphragmatic hernia Diaphragmatic eventration Gastric volvulus
  11. 11. GS GS GC GH GH Suspensory ligaments
  12. 12. Midgut volvulus Malrotation Colon Volvulus Malrotation
  13. 13. Types
  14. 14. Types of gastric volvulus Organo-axial Mesentro-axial Rotation around a line extending from the gastric cardia to the pylorus Rotation around an axis extending from the greater to the lesser curvatures
  15. 15. Types of sigmoid volvulus 180 degree of rotation 360 degree of rotation 540 degree of rotation Most common Mesenterico axial Organo-axial Twist around mesenteric axis Twist around longitudinal axis Closed loop obstruction No closed loop obstruction (one transition point)
  16. 16. Types of cecal volvulus Type I cecal bascule Type II Axial cecal volvulus Folding of the cecum anterior to the ascending colon Rotation of the distended cecum around the longitudinal axis of the ascending colon.
  17. 17. C.P
  18. 18. Age of presentation Gastric volvulus Midgut volvulus Sigmoid volvulus Cecal volvulus Pediatrics & adults Infants Old age (60-70) Old age (but younger than sigmoid volvulus).
  19. 19. C.P Gastric volvulus Midgut volvulus Sigmoid volvulus Cecal volvulus Acute volvulus: Borchardt triad: 1. Sever epigastric pain. 2. Violent retching without vomiting. 3. Difficulty in advancing in nasogastric tube. Chronic volvulus: Vague non specific symptoms. •Neonatal intestinal obstruction. •Bilious vomiting. •Abdominal distension. •Acute intestinal obstruction. •Acute intestinal obstruction.
  20. 20. Plain radiography
  21. 21. Volvulus Gastric volvulus Intrathoracic stomach with air fluid level Midgut volvulus Double bubble sign Colonic volvulus Sigmoid Coffe bean sign Cecal Marked cecal distension
  22. 22. Gastric volvulus • Intra-thoracic stomach with double air fluid level.
  23. 23. Gastric volvulus • Intrathoracic stomach with double air fluid level.
  24. 24. Midgut volvulus • Double bubble sign.
  25. 25. Sigmoid volvulus coffe bean sign
  26. 26. Sigmoid volvulus coffe bean sign
  27. 27. Northern exposure sign
  28. 28. Northern exposure sign
  29. 29. Cecal volvulus
  30. 30. Cecal volvulus SMA SMV Beak sign
  31. 31. Sigmoid volvulus Cecal volvulus sigmoid volvulus can only move upwards and usually goes to the right upper quadrant. Cecal volvulus however can go almost anywhere and can even be located in the pelvis. Sigmoid volvulus Vs cecal volvulus 1 A volvulus always extends away from the area of bowel twist.
  32. 32. Sigmoid volvulus Cecal volvulus Associated with large bowel dilatation. Associated with small bowel dilatation. Sigmoid volvulus Vs cecal volvulus 2
  33. 33. Barium
  34. 34. Volvulus Gastric volvulus Organo-axial Greater curvature above lesser curvature Mesentero-axial Gastric antrum above gastric fundus Midgut volvulus Cork scerw duodenum Colonic volvulus Sigmoid Beak sign Cecal Beak sign
  35. 35. Organo-axial gastric volvulus
  36. 36. Mesentero-axial gastric volvulus
  37. 37. Mesentero-axial gastric volvulus
  38. 38. Mesentero-axial gastric volvulus
  39. 39. Mesentero-axial gastric volvulus
  40. 40. Midgut volvulus • Cork screw duodenum & proximal jejunum.
  41. 41. Midgut volvulus • Cork screw duodenum & proximal jejunum. D S R
  42. 42. Sigmoid volvulus bird beak sign R S
  43. 43. Cecal volvulus bird beak sign R A D
  44. 44. CT
  45. 45. Volvulus Gastric volvulus Organo-axial Greater curvature above lesser curvature Mesentero-axial Gastric antrum above gastric fundus Midgut volvulus Malrotation (SMV to the left of SMA) Whirl sign Colonic volvulus Sigmoid Whirl sign Cecal Whirl sign
  46. 46. Organo-axial gastric volvulus
  47. 47. Organo-axial gastric volvulus
  48. 48. Organo-axial gastric volvulus
  49. 49. Organo-axial gastric volvulus
  50. 50. Organo-axial gastric volvulus
  51. 51. Organo-axial gastric volvulus
  52. 52. Organo-axial gastric volvulus
  53. 53. Organo-axial gastric volvulus
  54. 54. Organo-axial gastric volvulus
  55. 55. Organo-axial gastric volvulus
  56. 56. Organo-axial gastric volvulus
  57. 57. Organo-axial gastric volvulus
  58. 58. Organo-axial gastric volvulus Diaphragmatic hernia
  59. 59. Mesentero-axial gastric volvulus
  60. 60. Mesentero-axial gastric volvulus
  61. 61. Mesentero-axial gastric volvulus
  62. 62. Mesentero-axial gastric volvulus
  63. 63. Mesentero-axial gastric volvulus
  64. 64. Mesentero-axial gastric volvulus
  65. 65. Mesentero-axial gastric volvulus
  66. 66. Mesentero-axial gastric volvulus
  67. 67. Mesentero-axial gastric volvulus
  68. 68. Mesentero-axial gastric volvulus
  69. 69. PD Mesentero-axial gastric volvulus
  70. 70. Mesentero-axial gastric volvulus
  71. 71. Mesentero-axial gastric volvulus
  72. 72. Mesentero-axial gastric volvulus
  73. 73. EG Mesentero-axial gastric volvulus
  74. 74. Mesentero-axial gastric volvulus
  75. 75. Mesentero-axial gastric volvulus
  76. 76. Mesentero-axial gastric volvulus
  77. 77. Mesentero-axial gastric volvulus
  78. 78. Mesentero-axial gastric volvulus
  79. 79. Mesentero-axial gastric volvulus
  80. 80. Mesentero-axial gastric volvulus
  81. 81. Mesentero-axial gastric volvulus
  82. 82. Mid-gut volvulus (malrotation)
  83. 83. Mid-gut volvulus (malrotation)
  84. 84. Mid-gut volvulus (swirl sign)
  85. 85. Sigmoid volvulus
  86. 86. Sigmoid volvulus
  87. 87. Sigmoid volvulus
  88. 88. Sigmoid volvulus
  89. 89. Sigmoid volvulus
  90. 90. Sigmoid volvulus
  91. 91. Sigmoid volvulus
  92. 92. Sigmoid volvulus
  93. 93. Cecal volvulus
  94. 94. Cecal volvulus
  95. 95. Cecal volvulus
  96. 96. Cecal volvulus
  97. 97. Cecal volvulus
  98. 98. Cecal volvulus
  99. 99. Cecal volvulus
  100. 100. Cecal volvulus

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