SI Surgery

intestinal volvulus

obstruction by twisting intestines around mesenteric axis >360 degrees

total vs segmental volvulus

total - children, usually r colon

segmental - adults (men)

aspect of intestines and mesentery in volvulus

entero-mesenteric infarction - enlarged, red and edematous then looks like dead leaf, sometimes gangrenous

• peritoneal fluid bloody, fetid smell

symptoms volvulus

intestinal occlusion → violent pain, vomiting, distention (shock)

investigations volvulus

abd radiography

treatment volvulus

ER surgery w/ pre+intra+postop rebalancing

when is volvulus surgery conservative or radical

conservative - recent onset, intestine still viable

procedure volvulus surgery

detorsion, intestine washed w/ saline +/ lidocaine in mesentery, enteropexy to prevent relapse, if compromised → segmental resection

Intussusception

segment of intestine invaginates into adjoining lumen → obstruction, mostly in kids

types intussusception

secondary - mechanic obstacle

primary - unaffected bowel

intussusception usually progresses due to

intestinal peristalsis

where is most likely location of intussusception

ileocecal valve

2 types invaginations

simple (3 cylinders), complex (5-7 cylinders)

triad intussusception

vomiting, abd pain, blood passage by rectum

investigations intussusception

thick sausage-shaped intestinal loop on palpation

abd radiography

barium enema (but problem for surgery, US preferred)

conservative treatment intussusception

children in first 6h, enema (w/wo barium)

surgical treatment intussusception

intestinal reduction, if intestine viable → enteropexy, if not viable → resection + restoration continuity

______ is a necrotizing granulomatous nonspecific inflammation

Crohn’s disease

favourite location of crohn’s

terminal ileum

appearance of Crohn’s in acute + chronic stage

acute - red-purple, swollen, fibrin, thick and brittle wall, mesentery has inflammation and edema

chronic - cardboard-like, hypertrophied and rigid w/ sclerolipomatosis tissue, narrow lumen

what gives crohn’s a pseudotumoral appearance

mesentery is retracted and adherent to organs

what other aspects are present in crohns

chronic abscesses bw adhesions + fistulas

clinical picture crohns in acute phase

like acute appendicitis w/ diarrhea

types of clinical pictures of crohn’s (chronic)

• mimics UC - r iliac fossa pain 5-6h after food then diarrhea

• occlusive - Konig syndrome in r iliac fossa

• pseudotumoral - r iliac fossa tumour w/ inflammation + subocclusive symptoms, external fistulas

complications crohn’s disease

occlusions, perforations, fistulization

endoscopy of crohn’s

cobblestone like

lab crohn’s

hyperleukocytosis anemia

when is surgery indicated for crohn’s

only for complications - obstructions, fistulas, abscesses

only surgery that has some chance of curing crohn’s

resection bowel (multiple times over the yrs)

prognosis crohn’s

increased risk carcinoma

Meckel’s diverticulum

true diverticulum of intestine on antimesostenic edge of ileum, 100cm away from ileocecal valve

location meckel’s diverticulum

free in peritoneal cavity or fixed to umbilicus

__________ has a conical or cylindrical shape of 5-10 cm long and does not have its mesentery

meckel’s diverticulum

meckel’s diverticulum may be the site of what pathos

ulcer, bleeding, torsion, perforation, obstruction, tumours, incarcerated hernias of Littre

pathological forms of both meckel diverticulitis and appendicitis

catarrhal, phlegmonous, gangrenous, w or w/o perforation

clinical picture meckel diverticulum

umbilicus pain, m contraction, occlusive symptoms (more than appendicitis)

meckel’s diverticulum surgery

diverticulectomy, resection includes intestinal wall around base OR segemental resection of intestine (enterectomy)

diverticular ulcer or obstruction treatment

only surgery - diverticulectomy

where are adenomas usually

proximal portion of intestine

what tumour has dimensions of 2cm

leiomyoma

where are lipomas located

terminal ileum

symptoms of benign vs malignant tumours

benign have no specific symptoms

malignant - colicky pain, subocclusive symptoms, digestive bleeding, vomiting

investigations for tumours

CT, MRI

treatment tumours

only surgical - segmental intestine resection