A 92 year old lady presents with lower abdominal pain and distension. She is from a nursing
home and has history of dementia.
Describe the X-ray findings. (2)
Answer:
X-ray shows the classic coffee bean sign or bent inner tube sign. Grossly dilated sigmoid colon with apposed loop
of bowel .Closed loop obstruction of sigmoid colon.
Question 2
Incorrect
What is the diagnosis? (1)
Answer:
Sigmoid Volvulus
What is it? Sigmoid Volvulus
Chronic constipation could lead to large, elongated, atonic sigmoid colon.
Sigmoid loop full of faeces and distended with gas twists on mesenteric pedicle
causing a closed-loop obstruction.
What is the At risk group- Elderly, Chronic constipation, Megacolon i.e large redundant
pathophysiology? sigmoid colon .
Abdominal pain- colicky lower abdominal discomfort, distension and failure to
pass flatus or stool.
Vomiting
What are the Examination- Distended, Tympanic abdomen. Palpable mass may be present.
clinical features? PR- Empty rectum.
Pseudo-obstruction
Large bowel obstruction- Carcinoma of sigmoid colon
What are the
differential Constipation
diagnoses? Sigmoid diverticulum
What are the Bowel obstruction
complications? Colonic Ischaemia (Gangrenous bowel) with Perforation and faecal peritonitis.
Abdominal X-ray
CT Scan- Assessment of Bowel ischaemia
Diagnostic Barium enema - Classic Bird beak appearance(contrast material filling up the
evaluation colon). could result in decompression.
Surgical emergency- delay will increase risk of bowel ischaemia and
perforation.
Decompression- Sigmoidoscopy and Flatus tube- relieves obstructed loop.
Immediate Flatus tube is left in place for 24 hours to maintain decompression, prevent
treatment recurrence and recovery of vascular supply to bowel.
Blood stained stools and persistent abdominal pains indicates ischaemia -
Surgical intervention.
Surgery-Resection of sigmoid colon. Usually a double barrelled colostomy.
When is surgery (Paul-Mikulicz procedure)
indicated? Sigmoidectomy with primary anastamosis -definitive surgery.
, A 64 year old man presents with abdominal pains and distension. He has been vomiting and has not
opened her bowels or passed flatus for 3 days.
T 37.2 C, HR 110/ min BP 110/68 mmHG
Bloods- Na+ 132 mmol/L , K+ 2.8 mmol/L, Cl- 106 mmol/L, Urea 26, creat 290.
Answer:
The Abdominal x-ray shows
Multiple distended small bowel loops, Dilated small bowel loops, multiple air fluid levels , Valvulae
conniventes.
Small bowel obstruction.
Question 2
home and has history of dementia.
Describe the X-ray findings. (2)
Answer:
X-ray shows the classic coffee bean sign or bent inner tube sign. Grossly dilated sigmoid colon with apposed loop
of bowel .Closed loop obstruction of sigmoid colon.
Question 2
Incorrect
What is the diagnosis? (1)
Answer:
Sigmoid Volvulus
What is it? Sigmoid Volvulus
Chronic constipation could lead to large, elongated, atonic sigmoid colon.
Sigmoid loop full of faeces and distended with gas twists on mesenteric pedicle
causing a closed-loop obstruction.
What is the At risk group- Elderly, Chronic constipation, Megacolon i.e large redundant
pathophysiology? sigmoid colon .
Abdominal pain- colicky lower abdominal discomfort, distension and failure to
pass flatus or stool.
Vomiting
What are the Examination- Distended, Tympanic abdomen. Palpable mass may be present.
clinical features? PR- Empty rectum.
Pseudo-obstruction
Large bowel obstruction- Carcinoma of sigmoid colon
What are the
differential Constipation
diagnoses? Sigmoid diverticulum
What are the Bowel obstruction
complications? Colonic Ischaemia (Gangrenous bowel) with Perforation and faecal peritonitis.
Abdominal X-ray
CT Scan- Assessment of Bowel ischaemia
Diagnostic Barium enema - Classic Bird beak appearance(contrast material filling up the
evaluation colon). could result in decompression.
Surgical emergency- delay will increase risk of bowel ischaemia and
perforation.
Decompression- Sigmoidoscopy and Flatus tube- relieves obstructed loop.
Immediate Flatus tube is left in place for 24 hours to maintain decompression, prevent
treatment recurrence and recovery of vascular supply to bowel.
Blood stained stools and persistent abdominal pains indicates ischaemia -
Surgical intervention.
Surgery-Resection of sigmoid colon. Usually a double barrelled colostomy.
When is surgery (Paul-Mikulicz procedure)
indicated? Sigmoidectomy with primary anastamosis -definitive surgery.
, A 64 year old man presents with abdominal pains and distension. He has been vomiting and has not
opened her bowels or passed flatus for 3 days.
T 37.2 C, HR 110/ min BP 110/68 mmHG
Bloods- Na+ 132 mmol/L , K+ 2.8 mmol/L, Cl- 106 mmol/L, Urea 26, creat 290.
Answer:
The Abdominal x-ray shows
Multiple distended small bowel loops, Dilated small bowel loops, multiple air fluid levels , Valvulae
conniventes.
Small bowel obstruction.
Question 2
