Intestinal Obstruction & Pancreas

Question 1

Sigmoid volvulus radiography finding

Answer 1

Coffee bean appearance/
Bent inner tube sign

Question 2

Sigmoid volvulus contract enema x ray appearance

Answer 2

Birds beak appearance/ ace of spade apperance

Question 3

Inv of choice (IOC) in any bowel obstruction

Answer 3

CECT (adults)
USG (children)

Question 4

Management of sigmoid volvulus

Answer 4

1) no complications and patient stable:
- emergency— sigmoidoscopic decompression
- definitive—- sigmoidectomy or sigmoidopexy (derotate)

2) unstable— hartmann’s procedure

Question 5

How to differentiate Caecal form sigmoid volvulus on radiograph?

Answer 5

Caecal volvulus- apex towards left upper quadrant

Question 6

Types of stricturoplasty

Answer 6

1. Heinke Mikulicz
2. Finneys

Question 7

Meckels diverticulum

Answer 7

Remnant vitellointestinal duct
A true diverticulum because it has all the bowel layers
Antimesenteric border
Rule of 2:
2% population, 2inches long, 2 ft proximal to ileocaecal junction
20% has heterotopic mucosa

Question 8

The most sensitive investigation for GI bleed

Answer 8

Tc99 pertechnate scan

Question 9

Superior mesenteric artery syndrome
Aka

Answer 9

Wilkies/ cast syndrome

Question 10

Wilkies syndrome pathology

Answer 10

Angle between aorta & SMA = 25-25 deg (maintained by a pad of fat)
Angle obliterated in Anorexia, rapid weight loss, spinal cast.

Angle <20-22–> 3rd part of duo compressed

Question 11

IoC in SMA syndrome

Answer 11

CT angiography

Question 12

Annular pancreas

Answer 12

Malrotation of the ventral pancreatic bud causing encashment of second part of duodenum
• projectile non bilious vomitting
• X ray: double bubble sign
•ioc: CECT