Volvulus/intususseption Flashcards
What is intussusception?
When a part of the intestine folds in on itself causing obstruction
Most common cause of obstruction in infants
Ileocecal region (ileum fold into cecum)
Caused by: polyps/tumors (adults)
Lymphoid hyperplasia (babies)
Meckel’s diverticulim
Idiopathic
What are the risk factors for intussusception?
Having had one previously
Having a sibling with intussusception
Having intestinal malrotation
What are the signs of intussusception?
Intermittent abdominal pain Guarding Vomiting Hard, sausage like mass in abdomen Iscahemia- infarction Red currant jelly stool Sepsis, fever Obstruction - large mass Volvulus
What does intussusception look like on imaging?
A Bulls-eye telescoped intestine on end
What is a volvulus?
An obstruction caused by a loop in the intestines that twists around itself and surrounding mesentery
Sigmoid, cecal and midgut are the most common
When do sigmoid volvulus’ occur?
Pregnancy
Middle-aged and elderly- constipation (Hirschsprung)
Abdominal adhesions
When do cecal volvulus’ occur?
Abdominal mesentery didn’t develop normally
Colon can flop around freely
Fetus/stool
When do midgut volvulus’ occur?
Babies and small children
Abnormal intestinal development
What are the complications of a volvulus?
Bowel obstruction
Infarction
Sepsis (cardiovascular collapse)
What does a volvulus look like on imaging?
Abdo x-ray- Looks like a bent inner tube/coffee bean
Barium enema- birds beak
What are sigmoid volvulus associations?
older patients
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia
Strangulation symptoms
Usually volvulus/hernia
Increasing pain/tenderness + leucocytosis & systemic upset –> peritonism & absent bowel sounds
Sigmoid volvulus: elderly constipated patients
Caecal volvulus: congenital malrotation
