Sigmoid Volvulus

Sigmoid Vovulus

Sigmoid Volvulus

Volvulus is the twisting up of a loop of intestine on its mesenteric axis.

It can lead to partial or complete intestinal obstruction.

The volvulus is most common in the Sigmoid colon due to the long mesentery and comparatively loaded colon.

Radiological Appearance of Volvulus is called Omega Sign/ Inverted U Appearance or Pneumatic Tyre Appearance

Treatment

Resuscitation

Non operative decompression using a Rectal Tube

Laparotomy, Detorsion , Resection and primary anastamosis.

What is Volvulus Belt Countries?

 Volvulus Belt Countries are  South America, Africa , The Middle East, India and Russia, where the incidence of colonic volvulus is high.

Amyand's Hernia

Amyand's Hernia

Amyand's Hernia

What is an Amyand's hernia?

Amyand's hernia is an inguinal hernia with Vermiform Appendix as the content.

First documented successful appendectomy was done by Claudius Amyand, Sergeant-surgeon to King George II of England, in 1735.

What is an Inflamed Hernia?

When the hernia sac contains an inflamed organ like Vermiform Appendix, Salpynx or Meckel’s Diverticulum it is called Inflamed Hernia.

What is an Ogilvie Hernia?

A direct hernia occurring through the defect in the conjoint tendon is called Ogilvie hernia.

What is a Sliding Hernia/ Hernia-en-Glissade?

A hernia in which the viscous (Caecum /Left colon or Urinary Bladder) forms the posterior wall of the hernia sac.

What is a Richter’s Hernia?

A hernia in which the content is the circumference of the intestine.

What is a Littre’s Hernia?

A hernia in which the content is Meckel’s diverticulam

What is a Maydl’s  Hernia?

A hernia in which the content is W shaped loop of the intestine. Hence it is also called Hernia-en-W

What is a Giant Hernia?

A hernia which hangs down below the mid thigh of the patient on standing position is called a Giant Hernia.

What is Nyhus Classification of Hernia?

Type 1 : Indirect inguinal hernia, internal ring normal

Type 2 : Indirect inguinal hernia, internal ring dilated,

                   posterior inguinal wall intact;

                    inferior deep epigastric vessels not displaced

Type3 : Posterior wall defect

                    3a* Direct inguinal hernia

                    3b* Indirect inguinal hernia, internal ring dilated,           

                          medially encroaching on transversalis fascia

                    3c* Femoral hernia

 Type4 : Recurrent hernia

Torsion Testis

Torsion Testis

Torsion Testis - Left

 

Testicular torsion is a Surgical Emergency

Common Age Group: 10-25 Years

Clinical Features:

Sudden onset of pain in the testis, groin or Lower Abdomen

Associated nausea or vomiting may be present

The affected testis lies in a horizontal position or pulled up position.

Differential Diagnosis

Acute Epididymo Orchitis

Strangulated Inguinal Hernia

Testicular Trauma

In Acute Epididymo Orchitis, elevation of the testis or scrotal support results in the relief of  pain.

In Torsion testis elevation of the testis results in aggravation of  pain.

Specific Investigation

Doppler Ultrasound

Treatment

Scrotal Exploration. Untwist the torsion of the spermatic cord. Look for the viability of the testis. If the testis is viable, fix the tunica albugenia to the scrotal wall. If the testis is gangrenous a low orchidectomy is performed. Opposite side testis is also fixed as a precaution during the same operation.

Penetrating wound Abdomen-Splenic Injury

Penetrating wound Abdomen- Splenic Injury



Penetrating Stab Injury Abdomen



Management of Splenic Injury

Primary Survey and Resuscitation

      A- Airway maintenance with control of Cervical Spine

      B- Breathing

      C-Circulation-Intravenous Fluids

      D- Dysfunction of CNS Assessment

      E- Exposure in the Controlled Environment

Secondary Survey :- Detailed Head to Foot Examination Head to find out other associated Injuries:-

q Face

q Chest

q Abdomen

q Pelvis and Perineum

q Extremities

q General examination of vital signs

q Local Inspect anterior abdomen, lower thorax, perineum

q Log roll to inspect posterior abdomen.

Definitive care - Investigations and Treatment

  

Signs of Abdominal Trauma

Ø Tachycardia

Ø Hypotension

Ø Pallor

Ø Restriction of Abdominal Movements

Ø Grey Turners Sign/ Cullen’s Sign

Ø Rigidity

Ø Ballance’s Sign

Ø Absence of Bowel Sounds

What is Ballance’s Sign?

Ø Shifting Dullness on the Right of Abdomen

Ø Dull note on Percussion on the Left of Abdomen

Ø Due to Early Coagulation of Blood in the Left of Abdomen in Splenic Trauma

What is the difference between Guarding and Rigidity ?

Ø Guarding is the voluntary contraction of the abdominal wall muscles

Ø Rigidity is the involuntary contraction of the abdominal wall muscles

What are the treatment options available for Splenic Injury?

Non Operative Management ( Preferred)

Splenorraphy

Partial Splenectomy

Splenic Auto Transplantation

Splenectomy

What is the rationale of opting for Non Operative Management?

1.     To avoid complications with splenectomy like iatrogenic injury to the pancreas.

2.     To avoid immunosuppressive effects of Splenectomy-like OPSI ( Overwhelming Post Splenectomy Infection)

     

What are the indications of Angio Embolization in Splenic Injury?

1.     Extravasation of the contrast during CECT Abdomen

2.     Delayed splenic rupture/ Secondary splenic injury due the Pseudo Aneurysm Bleed.