Colorectal Emergencies

Question 1

Describe history of bowel perforation

Answer 1

Severe abdominal pain - can be gradual or acute onset. History of chronic constipation indicative of colon diverticular disease but CIBH indicative of colorectal cancer.

Question 2

What can bloods in bowel perforation show?

Answer 2

FBC - anaemia, thrombocytopenia, leukocytosis.
Renal profile - elevated urea and creatinine - AKI
Raised CRP - serum lactate is elevated

Question 3

What are imaging signs of perforation?

Answer 3

X-Ray: Pneumoperitoneum
CXR: Air under diaphragm
AXR: Rigler sign

Question 4

How is CT used to classify diverticulitis?

Answer 4

Hinchey classification used:
1: Localised
2: Generalised
3: Generalised purulent peritonitis
4: Generalised faecal peritonitis

Question 5

How is bowel perforation managed?

Answer 5

Resuscitation with IV Abx and IV fluids
Conservative - IV Abx
IR drainage
Laparotomy - resection +/- stoma ie Hartmann’s procedure

Question 6

Describe a bowel obstruction history

Answer 6

Main complaint is worsening constipation, absolute constipation and abdominal distension.
Acute: If due to volvulus/hernia
Gradual: Colorectal carcinoma
Background chronic constipation: Volvulus/CRC
Malignancy: Ask about red flag symptoms/constitutional symptoms
Previous abdo surgery: Adhesions
Vomiting

Question 7

What can a tender abdomen indicate in the case of bowel obstruction?

Answer 7

Think small bowel ischaemia as a result of acute dilatation.

Question 8

What can imaging indicate about bowel obsruction?

Answer 8

369 rule: 3cm for small bowel, 6cm for large bowel and 9cm for caecum count as dilated.
Coffee bean sign - if on the right, sigmoid volvulus. If on the left, caecal volvulus.

Question 9

How is sigmoid volvulus managed?

Answer 9

Endoscopic decompression