intestinal obstruction

Apr 16th, 2015
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SIGMOID VOLVULUSDefinitionAxial rotation or twisting of sigmoid colon on an axis formed by its mesentery. Result in partial or complete obstruction of the lumen and may be followed by circulatory impairment of the bowel which may lead to gut gangrene.Accounts for >50% of intestinal obstruction in parts of Africa. Commonest cause of large bowel obstruction.Predisposing factors1.High dietary fibre diet major contributing factor .2.Chronic constipation3.Long redundant colon4.Acquired megacolon eg.TB, Diabetes5.Narrowly based mesentery.Age-Occur in the elderly. -Peak age - >70yrs-Especially elderly patients suffering from psychiatric & chronic neurological diseases such as stroke or multiple sclerosis. -Also, cardiovascular disease and diabetes.Clinical presentationHistory1. Acute colicky abdominal pain usually with persistence of pain between spasms.May be a previous history of transient attacks in which spontaneous reduction of the volvulus has occurred.2.Abdominal swelling3. Constipation is absolute-obstipation.4. Vomiting-if present appear late.Physical examination1. Most striking finding is of a tensely distended, tympanitic, drum-like abdomen. 2. The rectum is empty of stool.3. Bowel sounds are often increased 4. Signs of peritoneal inflammation such as rebound tenderness or guarding are unusual. -When these signs are present they suggest that colonic infarction or gangrene has occurred. 5.Signs of dehydration may be apparent if presentation

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