Hajj Experience of

General Surgery department in

Al-Noor Specialist hospital

Dr.Meshal Al-Harthy, MDConsultant General Surgeon

April 2008

Dr.Mohammad Amin K MirzaSaudi Board of Surgery

Case 1

• 54 y.o• Turkish, male • Sudden abdominal pain , at the umbilical

area, for 4 hrs , severe in nature• Pt is in severe distress, tachepnic, &

hypotensive• Abdomen:Skin is dusky. Soft lax , mild

tenderness in umbilical region.

What is the next step?

• CXR: no free air

• AXR: Dilated large bowel localized at Rt side.

No leucocytosis

What to do??

• Whole small bowel gangrene?

• Whole large bowel gangrene?

• Part of small bowel & colon?

• Ischemia of intestine &multiple small Gangrenous patches throughout the jejunum?

Risk factors of mesenteric vascular occlusion

• Atrial fibrillation• Low circulatory state( CHF, Shock)• Dehydration• Excessive exercise• Protein S defficiency

Case 2

• 23 y Saudi , male Pt• Sudden onset of sever abdominal pain &

constipation• Generally stable, but in sever pain• Abdomen is distended , tender all over ,, with

guarding

Next step!!!!

What management options we have?

volvulus

• More common in men, occurringin 63.7% of men. • The average age at which sigmoid volvulus occurs in

English-speaking countries is 60 to 65 years, although it tends to occur 15 to 20 years earlier in other parts of the world.

• Black > White

• Types:• Caecal• Transverse colon• Sigmoid

Colon Resection

Primary anastomosisor

colostomy?

On Table lavage

Sigmoid Decompression and Colopexy

Salim AS. Management of acute volvulus of the sigmoid colon: a new approachby percutaneous deflation and colopexy. World J Surg 1991; 15:68–73.

Mesosigmoidoplasty

Foley Catheter Sigmoidostomy

T-Fasteners Sigmoidopexy

Gallagher et al.

Colopexy & Cecostomy