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VOLVULUS Alam Zeb Amir

Roll no : 09

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.

PresentationHistory: Abdominal pain, distension, no flatus or bowel movementsExamination: Distension of abdomen, mild tenderness, palpable mass

TYPES OF VOLVULUS

MIDGUT VOLVULUS

CECAL VOLVULUS

SIGMOID VOLVULU

S

GASTRIC VOLVULUS

CAUSESPREDISPOSING FACTORSOne with a normal anatomic variation

resulting in extra colonic loopsPatients with muscular dystrophy due to

the smooth muscle dysfunctionCongenital intestinal malrotationAbnormal intestinal contents e.g.

meconium ileus or adhesionsChronic constipation

CLINICAL FEATURESAbdominal distensionvomiting Ischemia (Necrosis)Absolute constipationFeatures of peritonitisSevere pain and progressive injury to the

intestinal wallAccumulation of gas and fluid

DIAGNOSTIC INVESTIGATIONS

Laboratory investigations1. FBC ( WBC)

2. Urea & Electrolytes Plain radiographyContrast studiesOther imaging studies 1. Ultrasound

2. CT Scan

X-RAY

Barium Enema

TREATMENTSigmoidoscopy (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

PRE-OPERATIVEProcedure and relief of psychological

stressLow residue dietAntibiotic e.g neomycin, streptomycin,

etcNasogastric or intestinal tube

POST OPERATIVEUntil peristalsis return, anything to be given is

introduced parenteralCatheterizeAnalgesicsManage rectal tube sutured in the anus to

facilitate the passage of stoolNeostigmine

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

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