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intestinal volvulus
obstruction by twisting intestines around mesenteric axis >360 degrees
total vs segmental volvulus
total - children, usually r colon
segmental - adults (men)
aspect of intestines and mesentery in volvulus
entero-mesenteric infarction - enlarged, red and edematous then looks like dead leaf, sometimes gangrenous
peritoneal fluid bloody, fetid smell
symptoms volvulus
intestinal occlusion → violent pain, vomiting, distention (shock)
investigations volvulus
abd radiography
treatment volvulus
ER surgery w/ pre+intra+postop rebalancing
when is volvulus surgery conservative or radical
conservative - recent onset, intestine still viable
procedure volvulus surgery
detorsion, intestine washed w/ saline +/ lidocaine in mesentery, enteropexy to prevent relapse, if compromised → segmental resection
Intussusception
segment of intestine invaginates into adjoining lumen → obstruction, mostly in kids
types intussusception
secondary - mechanic obstacle
primary - unaffected bowel
intussusception usually progresses due to
intestinal peristalsis
where is most likely location of intussusception
ileocecal valve
2 types invaginations
simple (3 cylinders), complex (5-7 cylinders)
triad intussusception
vomiting, abd pain, blood passage by rectum
investigations intussusception
thick sausage-shaped intestinal loop on palpation
abd radiography
barium enema (but problem for surgery, US preferred)
conservative treatment intussusception
children in first 6h, enema (w/wo barium)
surgical treatment intussusception
intestinal reduction, if intestine viable → enteropexy, if not viable → resection + restoration continuity
______ is a necrotizing granulomatous nonspecific inflammation
Crohn’s disease
favourite location of crohn’s
terminal ileum
appearance of Crohn’s in acute + chronic stage
acute - red-purple, swollen, fibrin, thick and brittle wall, mesentery has inflammation and edema
chronic - cardboard-like, hypertrophied and rigid w/ sclerolipomatosis tissue, narrow lumen
what gives crohn’s a pseudotumoral appearance
mesentery is retracted and adherent to organs
what other aspects are present in crohns
chronic abscesses bw adhesions + fistulas
clinical picture crohns in acute phase
like acute appendicitis w/ diarrhea
types of clinical pictures of crohn’s (chronic)
mimics UC - r iliac fossa pain 5-6h after food then diarrhea
occlusive - Konig syndrome in r iliac fossa
pseudotumoral - r iliac fossa tumour w/ inflammation + subocclusive symptoms, external fistulas
complications crohn’s disease
occlusions, perforations, fistulization
endoscopy of crohn’s
cobblestone like
lab crohn’s
hyperleukocytosis anemia
when is surgery indicated for crohn’s
only for complications - obstructions, fistulas, abscesses
only surgery that has some chance of curing crohn’s
resection bowel (multiple times over the yrs)
prognosis crohn’s
increased risk carcinoma
Meckel’s diverticulum
true diverticulum of intestine on antimesostenic edge of ileum, 100cm away from ileocecal valve
location meckel’s diverticulum
free in peritoneal cavity or fixed to umbilicus
__________ has a conical or cylindrical shape of 5-10 cm long and does not have its mesentery
meckel’s diverticulum
meckel’s diverticulum may be the site of what pathos
ulcer, bleeding, torsion, perforation, obstruction, tumours, incarcerated hernias of Littre
pathological forms of both meckel diverticulitis and appendicitis
catarrhal, phlegmonous, gangrenous, w or w/o perforation
clinical picture meckel diverticulum
umbilicus pain, m contraction, occlusive symptoms (more than appendicitis)
meckel’s diverticulum surgery
diverticulectomy, resection includes intestinal wall around base OR segemental resection of intestine (enterectomy)
diverticular ulcer or obstruction treatment
only surgery - diverticulectomy
where are adenomas usually
proximal portion of intestine
what tumour has dimensions of 2cm
leiomyoma
where are lipomas located
terminal ileum
symptoms of benign vs malignant tumours
benign have no specific symptoms
malignant - colicky pain, subocclusive symptoms, digestive bleeding, vomiting
investigations for tumours
CT, MRI
treatment tumours
only surgical - segmental intestine resection
Note
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