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Hajj Experience of General Surgery department in Al-Noor Specialist hospital Dr.Meshal Al-Harthy, MD...
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Transcript of Hajj Experience of General Surgery department in Al-Noor Specialist hospital Dr.Meshal Al-Harthy, MD...
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