Surgery management of the GI tract

Question 1

what is the presentation of large bowel obstuction?

Answer 1

• No evidence of previous abdominal operation
• No evidence of strangulated external hernia
• vomiting late or absent
• grossly distended abdomen due to size of large bowel

Question 2

what is the presentation of small bowel obstruction?

Answer 2

• 2x commonest cause of small bowel obstruction are previous abdo operation and strangulated external hernia
• early and profuse vomiting
• less distended than large bowel

Question 3

what is the Abdo xray finding for volvulus of sigmoid colon?

Answer 3

• Enormously distended oval gas shadow, looped on itself to give typical ‘bent inner-tube sign’ or ‘coffee bean sign’
• Haustae don’t extend across the width of the gas shadow, suggesting large intestine

Question 4

what is the treatment for sigmoid volvulus?

Answer 4

• Conservative management effective in treating majority of patients with a sigmoid volvulus
• Sigmoidoscope is passed with patient in left lateral position
• Usually untwist volvulus, with release of vast quantities of flatus and liquid faeces

Question 5

what happens to an untreated sigmoid volvulus?

Answer 5

loop of sigmoid with blood supply cut off by torsion= necrosis

Question 6

what surgery can be done for sigmoid volvulus?

Answer 6

exploratory laparotomy & sigmoid colectomy with end colostomy (Hartmann’s procedure)

• Cut off area required and reattach