Volvulus is rotation of part of the intestine around its mesentry, causing a intestinal obstruction. Colonic volvulus is not common cause of intestinal obstruction in the developed world. However much more common in the developing world (6,7). High prevalence of volvulus are reported in the “Volvulus Belt” of Africa, the Middle East, India, and Russia. In these regions, the average age is younger than Western countries, ranging from 40 to 50 years and in generally better health (8). In the United States, colonic volvulus accounts for 10 to 15% of all colon obstructions(9). The sigmoid colon is most common site followed by caecum for volvulus. Transverse colon volvulus is an uncommon cause of intestinal obstruction. Literature …show more content…
Twisting of bowel commonly occurs along the mesenteric axis , resulting in venous obstruction and eventually arterial compromise. Redundancy and non-fixation of bowel are essential to form any type of volvulus. The ascending and descending segments of the colon are not mobile , but the sigmoid colon, caecum, and transverse colon are not fixed within the peritoneum, tethered by their mesentery. This mobility contributes volvulus to occur at these locations. Thirty three to thirty five percent of patients with volvulus of the transverse colon appear to have had a history of chronic constipation which is either idiopathic or secondary to autonomic dysfunction (5) . In our patient chronic constipations , laxative abuse and high fibre diet may be contributing for the transverse colon volvulus . These conditions may predispose the elongation and chronic redundancy of the colon and its mesentry, which favoure it to rotation. In our part of world , most of people are farmer and they eat high fibre content diet, that may be reason for high incidence of volvulus. Honestely , it is difficult to conclude the broad conclusions regarding the incidence of transverse colon volvulus in the adult population due to the relatively small number of reported cases. Therefore, surgeon should be aware of these unusal causes of large bowel obstruction to allow for early diagnosis and to facilitate better patient
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Following the CT scan findings, nasogastric (NG) tube feeding was stopped immediately and general surgery team was consult. On the same day, Mr. S underwent a right hemicolectomy with end-ileostomy for ischemic bowel. The intra-operative findings include dilated right colon and transverse colon, a foot long necrotic terminal ileum, and necrotic right colon up to close to the hepatic. Brooke ileostomy was perfomed. The stoma located at right lower quadrant (RLQ) of the
Please review the information available in DocuCare patient chart, including demographics, notes, diagnostics, assessments and flow sheet. Included in the "notes" section is a history and physical (H & P) which includes a review of systems (ROS), past history and family history as well as the physical exam (PE).
The anatomy of colon cancer is very intriguing. The colon is part of the gastrointestinal system. The colon is approximately six feet long and one to two inches in diameter. The colon has a few different parts. The main four are the ascending colon, the descending colon, and the sigmoid colon. The colon also includes the cecum, the rectum and the anus. The colon starts at the cecum and then continues as the ascending colon. It is then a right hepatic flexure and turns into the transverse colon. The transverse colon then turns at the left splenic flexure and is the descending colon. The descending colon turns left and is than called the sigmoid colon. The sigmoid colon then descends and is then called the rectum and then the anus. The colon is meant to absorb water and nutrients. It is also meant to break down food and store waste until it is time to excrete them.
Large intestine is responsible for absorbing water from the stool and propelling it towards the anus for the excretion (Marieb & Hoehnm 2012, p.890). However, when the motility of large intestine for this propulsive movement gets slowed, the outcome is constipation (Southwell, 2010). Constipation can be defined as emptying stools fewer than 3 times per week (Kumar, Barker, & Emmanuel, 2014); it can be caused by use of codeine phosphate: opioid induced constipation (Kumar et al., 2014).
A 59-year-old male, whose initials have been changed to “J.S.” due to confidentiality purposes, will be the patient for this paper. J.S. was admitted on January 12, 2014 to the Emergency Room (ER) complaining of vomiting every 15 minutes and abdominal pain rated at eight out of ten, on a scale where ten is the highest pain level. J.S. described his abdominal pain as “expanding from the inside of my stomach” (personal communication, January 15, 2014). J.S. was assessed and had an X-ray and Computed Tomography (CT) scan preformed while he was in the ER. The X-ray showed that his small bowel was distended as much as five to six centimeters, and filled with air and gaseous. A CT scan of his abdomen and pelvic region showed a narrowing of the GI tract lumen (J.S., Medical Chart, January 15, 2014). J.S.’s admitting diagnosis was a Small Bowel Obstruction (SBO), which is a form of intestinal obstruction where the lumen of the small intestine
Gastrointestinal presentations which include: failure to thrive leading to poor growth and development in children, steatorrhea leading to frequent greasy and bulky stools, pancreatic manifestations such as pancreatic insufficiency, recurrent acute pancreatitis and chronic pancreatitis, intestinal defects like meconium ileus, distal intestinal obstruction syndrome and rectal prolapse and hepatic problems like prolonged neonatal jaundice (Kumar et al
Immediate need to move your bowels when you wake up or during or after meals
“Abdomen is a Pandora’s magical box which cannot be explained unless opened”. My interest in Gastro intestinal pathology arouse during the post-graduation period due to the wide implications it focus. It is a sophisticated and complex area
A malrotation of the gut occurs when something goes wrong during development the small intestine (gut or small bowel). When this occurs, the small intestine is not fixed in the abdomen (belly). The intestines are held by just their blood supply. When the intestines become twisted, because they are not fastened down, it cuts off their blood supply. It is much like a hose getting kinked. This loss of blood supply leads to damage to the gut. This condition is also called volvulus.
Diverticular bleeding is a common cause of lower gastrointestinal haemorrhage. Severe haemorrhage can arise in 3-5% of patients with diverticulosis. The site of bleeding may more often be located in the proximal colon.
Intussusception is the folding of a segment of the intestine into another further downstream and is the most common cause of intestinal obstruction in children 3 months to 6 years. Intussusception occurs primarily in infants (most often male and female), but can also occur in adults.
Small bowel obstruction (SBO) is a blockage that keeps food or liquid from passing through the small intestine or large intestine. It can be partial or complete. This disorder is very irritable and causes many discomforts like abdominal cramping, fever, “Abdominal pain, abdominal distention, nausea, and vomiting are the usual signs and symptoms of SBO” (Barzegari, et al. 2016, p. 201). According to Buttaro et al. (2013), the three differential diagnoses that can be included with this disorder are ischemic colitis, paralytic ileus, and gastroenteritis. Bowel obstruction occurs when the normal flow of intraluminal contents is interrupted. According to Bordeianou, et al. (2016), the pathology that causes the obstruction may be external to the
The pattern was unremarkable without any ulcerations, edema, or colitis. ______ polyps were identified. Left-sided diverticula identified but no evidence of any active diverticulitis. Scope was then retroflexed into the rectum internal hemorrhoids were identified as well as what appeared to be two distal rectal polyps and then the scope was then withdrawn. Once this is done a bivalve anoscope was introduced and all anal crypts were inspected no evidence of any fissures were noted; however, in the posterior midline patient was noted to have an anal fistula. A probe was introduced into this and then the fistula itself was then opened. The base of it was then cauterized and once this was done, the defect was then closed primarily using a running interlocking suture of 2-0 Vicryl. Internal hemorrhoids were identified in the right and left anterior positions and these were ligated using a rubber band ligator. The patient was also noted to have two distal rectal polyps, one noted in the anterior position as well as one noted in the
From 60 patients; 20 cirrhotic patients with gastric varices were selected with risk factors of bleeding as INR≥ 2, platelet count ≤80000/µl, serum total bilirubin≥2mg/dl, serum creatinine ≥ 1.5 mg/dl. The feeding vessel in GOV is the cardiac branch of the left gastric vein which enters the stomach 2-3 cm from the gastro-esophageal junction. The feeding vessel of IGV is a branch of the short gastric vein ; it is the most prominent one which was ligated; if the feeding vessel was not apparent then the peripheral margins of varices were ligated.
Perhaps, in no other region of the body does one find more opportunities for effective diagnosis, than in the case of the rectum. Unfortunately, ignorance of methods of analysis and arriving at a clinical diagnosis is surprisingly rampant in most of the recent medical graduates. Those who are coming to the hospitals as interns have only a little idea of evenabout the anatomy of the rectum and anus. The frequency with which rectal examination is performed in general practice is inadequate. Up to two-thirds of patients who present have anorectal symptoms do not undergo a rectal examination and are rarely referred to a specialist. It is unfortunate as a third of rectal cancers are palpable, the omission of the routine anorectal examination may lead to delays in referral for resectable malignancy.