Volvulus & Intussusception

Syaiful Mukhtar
 Volvulus

• Volvulus refers to the twisting of a portion of

the intestine around itself or a stalk of
mesentery tissue to cause an obstruction.
Volvulus occurs most frequently in the colon,
although the stomach and small bowel can
also twist
 Volvulus

• The part of the digestive system above the

volvulus continues to function and may swell as it
fills with digested food, fluid, and gas. A condition
called strangulation develops if the mesentery of
the bowel is twisted so tightly that blood flow is
cut off and the tissue dies. This condition is called
gangrene. Volvulus is a surgical emergency
because gangrene can develop quickly, cause a
hole in the wall of the bowel (perforation), and
become life-threatenin
 Signs & Symtoms
Abdominal pain
• Constipation
• Blood in stool
• Nausea
• Vomiting
Bowel obstruction ..
Gastric volvulus
Caecal volvulus
Ileal volvulus
Tranversal colon volvulus
Sigmoid volvulus
 Diagnostic

• Physical examination
• Radiology
• Endoscopy
Diagnostic
 Treatment

• Surgery
• Reposition, resection and anastomosis
 Intussusception

• Intussusception is when one segment of

intestine "telescopes" inside of another
causing an intestinal obstruction. Although it
can occur anywhere in the gastrointestinal
tract, it usually occurs at the junction of the
small and large intestine
• The obstruction can cause swelling &
inflammation that can lead to tearing of the
intestines
 Intussusception
• Intussusception’s cause is unknown, but is
usually preceded by a virus that produces
swelling of the lining of the intestine, which
then prolapses into the downstream intestine.
In some children, it is caused by a congenital
anomaly of the intestine such as a polyp or
diverticulum
Intussusception
 symptoms of intussusception
• The characteristic signs and symptoms of
intussusception are episodic, severe, crampy
abdominal pain alternating with periods of
lethargy. Small children may draw their knees up
to their chest. Other possible symptoms of
intussusception include:
• Nausea and vomiting
• Rectal bleeding (red jelly-like stools) sometimes
mixed with mucus
• These symptoms begin abruptly, usually one
week after a non-specific viral illness.
 Diagnostic

• Intussusception is associated with an

abdominal mass, which may be felt upon
physical examination. Ultrasonography is able
to identify the mass with 100 percent
accuracy and is now the first radiologic test
prescribed for patients with suspected
intussusception. Two other radiologic tests--
barium enema and air contrast enema--also
are used to help diagnose intussusception
Diagnostic
Treatment
Treatment
 Treatment

• Once intussusception is diagnosed, the next step is to

attempt hydrostatic reduction (to push the intestine back)
using a barium enema or air contrast enema (same test
used for diagnosis). This is a radiologic procedure not a
surgical procedure and does not require a general
anesthetic.
• These procedures (barium enema and air contrast enema)
have a 60 percent to 70 percent success rate, with an 8
percent to 10 percent rate of intussusception recurrence.
They have a low risk of complications as well. If hydrostatic
reduction is unsuccessful, then surgery is required. Surgery
may also be done if there is significant infection, or are too
ill for the radiologic procedure
Thanks u