sigmoid volvulus.pptxerrtyiioppknjiopplmnnbvgffdd

D

1. APPROACH TO LARGE-BOWEL OBSTRUCTION MODERATOR:DR.BHAGYALAKSHMI ASSISTANT PROFESSOR PRESENTOR:DR.PRANAVI

2. Abdominal radiograph Barium enema CT

3. elderly insidious onset symptoms include abdominal pain, constipation or obstipation, and abdominal distension The major sites of obstruction include the cecum, hepatic and splenic flexures, and recto-sigmoid colon. LBO occurs more frequently within the left colon(manifests earlier) competence of the ileocecal valve exact size of the cecum is less important than the duration and rapidity of cecal distension

4. Merits of Abdominal Radiography Size the colon is dilated proximal to the site of obstruction with a paucity or absence of gas distal to the obstruction . Air-fluid levels{acute} are often seen in the dilated colon on the upright or decubitus radiographs . pneumatosis, portal venous gas, and pneumoperitoneum. The presence of rectal gas should not exclude the diagnosis of LBO.

5. Challenges of Abdominal Radiography in Patients with LBO Pseudo-obstruction, without mechanical obstruction ACPO (also known as Ogilvie syndrome). perforation may occur with ACPO The presence of rectal gas should not exclude the diagnosis of LBO, but frank distention of the rectum implies a colonic ileus.

6. MULTIDETECTOR CT intraluminal, mural, and extramural causes of LBO modality for the detection of inflammation and bowel ischemia. dilated large bowel proximal to a transition point and decompressed bowel distal to the obstruction. PITFALLS Spasm at the splenic flexure “colon cut-off” sign short annular desmoplastic colonic lesions on CT scans

7. Contrast Enema easy distinction between a LBO and colon pseudo-obstruction Water-soluble iodinated contrast material Transition point

8. Sigmoid volvulus Sigmoid volvulus is the abnormal twisting of the sigmoid colon along the mesenteric axis, which leads to a closed-loop obstruction.

9. Plain radiograph coffee bean sign Frimann -Dahl sign - three dense lines converge towards the site of obstruction absent rectal gas liver overlap sign northern exposure sign

10. Cofee bean northern exposure sign sign

11. Frieman dahl sign liver overlap sign

12. Bird beak sign

13. CT Large gas-filled loop lacking haustra, forming a closed-loop obstruction whirl sign : twisting of the mesentery and mesenteric vessels bird beak sign: if rectal contrast has been administered X-marks-the-spot sign: crossing loops of bowel at the site of the transition split wall sign : mesenteric fat seen indenting or invaginating the wall of the bowel steel pan sign:

14. Whirl pool bird beak

15. Split wall sign mesenteric fat seen indenting or invaginating the wall of the bowel

16. Caecal volvulus abdominal radiography displacement of the cecum out of the right lower quadrant. contrast enema, a classic beak sign will be demonstrated in the displaced ascending colon Apex of the cecal twist in the left upper quadrant.

17. Caecal vovulus

18. Colonic carcinoma

19. Ogilive syndrome Pseudoobstruction due to interruption of sympathetic innervation Symptoms occur quickly marked colonic distension predominantly involving the cecum, ascending colon, and transverse colon. Risk of perforation

20. Ogilive syndrome

21. Sigmoid diverticulitis

22. Inflammatory bowel disease

23. hernias

24. Colonic intussesception

25. Intraluminal obstruction gallstones, enteroliths, intentionally inserted foreign body, medications, and illegal drugs. Fecal impaction most common cause.

26. External compression endometriosis, lymphadenopathy, pancreatitis, intra-abdominal abscesses, mesenteric or colonic surface involvement of peritoneal carcinomatosis. direct invasion from gynecologic or prostatic malignancies.

27. External compression

28. THANK YOU