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
pathophysiology? At risk group- Elderly, Chronic constipation, Megacolon i.e large redundant sigmoid colon .
Abdominal pain- colicky lower abdominal discomfort, distension and failure to pass flatus
or stool.
Vomiting
Examination- Distended, Tympanic abdomen. Palpable mass may be present.
What are the
clinical features? PR- Empty rectum.
Pseudo-obstruction
Large bowel obstruction- Carcinoma of sigmoid colon
What are the Constipation
differential
diagnoses? Sigmoid diverticulum
Bowel obstruction
What are the
complications? Colonic Ischaemia (Gangrenous bowel) with Perforation and faecal peritonitis.
Abdominal X-ray
CT Scan- Assessment of Bowel ischaemia
Barium enema - Classic Bird beak appearance(contrast material filling up the colon). could
Diagnostic
evaluation result in decompression.
Surgical emergency- delay will increase risk of bowel ischaemia and perforation.
Decompression- Sigmoidoscopy and Flatus tube- relieves obstructed loop. Flatus tube is
left in place for 24 hours to maintain decompression, prevent recurrence and recovery of
Immediate
treatment 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.(Paul-Mikulicz
procedure)
When is surgery
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
Apart from Neoplasm, list 2 common causes of the above condition?
Answer:
Adhesions, strangulated hernia, IBD, Intussusception, volvulus, Gall stones etc.
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
pathophysiology? At risk group- Elderly, Chronic constipation, Megacolon i.e large redundant sigmoid colon .
Abdominal pain- colicky lower abdominal discomfort, distension and failure to pass flatus
or stool.
Vomiting
Examination- Distended, Tympanic abdomen. Palpable mass may be present.
What are the
clinical features? PR- Empty rectum.
Pseudo-obstruction
Large bowel obstruction- Carcinoma of sigmoid colon
What are the Constipation
differential
diagnoses? Sigmoid diverticulum
Bowel obstruction
What are the
complications? Colonic Ischaemia (Gangrenous bowel) with Perforation and faecal peritonitis.
Abdominal X-ray
CT Scan- Assessment of Bowel ischaemia
Barium enema - Classic Bird beak appearance(contrast material filling up the colon). could
Diagnostic
evaluation result in decompression.
Surgical emergency- delay will increase risk of bowel ischaemia and perforation.
Decompression- Sigmoidoscopy and Flatus tube- relieves obstructed loop. Flatus tube is
left in place for 24 hours to maintain decompression, prevent recurrence and recovery of
Immediate
treatment 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.(Paul-Mikulicz
procedure)
When is surgery
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
Apart from Neoplasm, list 2 common causes of the above condition?
Answer:
Adhesions, strangulated hernia, IBD, Intussusception, volvulus, Gall stones etc.
