3. OUTLINE CONT’
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
◦ Sigmoid ~ 65%
◦ Cecum ~25%
◦ Transverse colon ~4%
◦ 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
Person’s 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 CONT’
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
◦ Same admission
Emergent laparotomy
◦ 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
CONT’
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
CONT’
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. Moroney’s Surgery for
Nurses, London: Churchil Livingston.
Bloom. , A and Bloom, S.R. Toohey’s
Medicine for Nurses, London: churchil
Livingstone
Reynolds Watson, J.E., Watson’s 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 “upside-down” stomach. This is called “organoaxialvolvulus”.
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 “mesentero-axial volvulus”
Rotation of the stomach about both the organoaxial and mesenteroaxial axes is termed “combined volvulus”.
