General: Sigmoid Volvulus Flashcards
Outline the pathophysiology of Sigmoid Volvulus
Twisting of a loop of intestine around its mesenteric attachment
Affected bowel can become ischaemic due to compromised blood supply = bowel necrosis and perforation
Most volvuli occur at the sigmoid colon = long mesentery
What are the risk factors of Sigmoid Volvulus?
Neuropsychiatric disorders
Resident in a nursing home or advanced age
Chronic constipation or laxative
Male gender
Previous abdominal surgeries
Diabetes mellitus
What are the symptoms of Sigmoid Volvulus?
Vomiting is a late sign
Colicky pain
Abdo distension
Absolute constipation
Increased bowel sounds
Increased tympanic percussion
How would you investigate Sigmoid Volvulus?
Bloods = FBC, U+Es, Ca2+, TFTs
AXR = coffee-bean sign from the LIF, if the ileocaecal valve is incompetent, the AXR will also show signs of small bowel dilatation
CT = if suspected ischemia, whirl sign
How would you manage Sigmoid Volvulus?
Acute:
- NBM
- IV fluids
- bloods + lactate
- CT AP
Decompression with a sigmoidoscope and insertion of a flatus tube
Sigmoidoscope = pt in L lateral, lubricated sigmoidoscope into rectum, manoeuvred to twisted bowel, once in the correct position there will be a rush of air and liquid faeces as the obstruction is relieved
Flatus tube = left in situ for up to 24hrs, to allow for continued passage of contents and recovery
Surgery = sigmoidectomy with primary anastomosis
What are the complications of Sigmoid Volvulus?
Bowel ischemia
Bowel perforation
Recurrence (up to 90% of pts)
From stoma placement
What are the 2 different types of Stoma?
- END = a pipe divided across its entire circumference
2. LOOP = fluid can still pass through the lumen, but the majority is passed through the proximal end
Which organs most commonly perforate?
Stomach
Intestine
Oesophagus
Define peritonitis?
Inflammation of the peritoneum typically caused by a bacterial infection either via the blood or after rupture of an abdominal organ
What initial radiological test should be performed to diagnose perforation?
eCXR = erect chest x-ray will show air under the diaphragm (pneumoperitoneum) if an abdominal organ has perforated
When is it necessary to form a stoma?
Colostomy = colon cancer, intestinal obstruction, necrotic bowel, trauma (gunshot), abscess, diverticulitis
Ileostomy = relieve inflam in the colon (Crohns, UC), allow complex surgery on the anus or rectum
Urinary stoma (urostomy) = removal of the bladder, defective bladder (congenital, surgery or spinal injury)
What is a Hartmann’s procedure?
- Resection of the rectosigmoid colon
- Closure of the anorectal stump
- Formation of an end colostomy
Purpose = treat colon cancer or inflammation (proctosigmoiditis, proctitis, diverticulitis)
