Small bowel volvulus

Small bowel volvulus

    * Introduction
    * Causes and Risk Factors
    * Signs and symptoms
    * Diagnosis
    * Treatment
Intestinal volvulus is the twisting loops around the axis or mesenteric. In children is generally related to a congenital defect or rotation of the mesentery acolare and adults is an obstacle to secondary intestinal peristalsis and the bracket is made, the tumor or a retractable mesenteric process.
Consists of turning the small intestine volvulus around the mesenteric axis, fully or partially. The small child is almost always a loop of umbilical primitive volvulus due to lack of common acolare the mesentery. At this part with small intestine obstruction, the check, right third of the ascending colon transverse. The adult is partially meets volvulus secondary to a barrier, which favors fixind twisting his intestine. Most commonly it is a congenital or more clamps (Meckel diverticulum) or surgery or postinflamator earned, viscero-visceral and viscero-parietal. Twisting their headquarters in the middle or lower segment jejunoileonului.
Small bowel volvulus is seen by all the signs of small bowel obstruction by strangulation. Pain is alive, vomiting are early transit stop is complete. In the first hour can be observed based discrete paraombilical bloating, sounding tympanic renitenta to palpation.
Malrotatiei symptoms in children is common in young ages. Children under 1 year include 75-90% of cases, with 50% of them in children under 1 month and 25-40% in children in the first two weeks of life.
The most common complications are adhesive obstructions, short bowel syndrome and recurrent volvulus. Short bowel syndrome with its associated complications of long-term parenteral nutrition (sepsis, mental retardation, hepatobiliary dysfunction) is associated with high rates of mortality. In patients with intestinal necrosis factor length of bowel resection is dependent on patient survival.
Therapy is surgical. In the presence of the bride is untwisting is sectioned and loop. If gangrene is stretched will be segmental bowel resection with restoration of transit at the same time. Postoperative massive rehydration is the same, accompanied by aspiration and antibiotic digestive continue. Volvulus prognosis depends heavily inetrventia correct diagnosis and early surgery to prevent necrosis bowel.
Pathogenesis
Malrotation and volvulus are two distinct entities. Malrotation may lead to incomplete and intermittent signs and symptoms of intestinal obstruction with proximal mesenteric congestion. If volvulus has developed as a consequence of malrotatiei intestinal obstruction is typically complete and compromising blood flow due to twisting mesentery and intestinal blockage superior mesenteric artery vascular pedicle. Therefore, symptoms depend on the degree of ischemia. It can vary from lymphatic and venous congestion with edema secondary intestinal necrosis simple until arterial and venous thrombosis.
Once you have developed bowel ischemia, pain becomes more pronounced and the patient may present with signs of acute abdomen painful stiffness and tenderness to palpation.
Since superior mesenteric aretrei territory includes parts of the duodenum proximal transverse colon up to the entire Middle colon volvulus can become necrotic if not corrected in time. Entire bowel necrosis middle is not compatible with life.
Frequent rotation abnormalities can be divided into stages of occurrence. Stopping in the first stage of evolution in the herniated intestine let cord forcing omfalocele channel. Stopping the second stage of development may cause nonrotatie, incomplete rotation, hiperrotatie or reverse rotation. In addition during this period may occur gastroschizisul and diaphragmatic hernias. Stop development in the third stage result in a mobile cecum, duodenum, or unattached unattached to the small intestine mesentery, which allows Caecal volvulus and internal hernias.
If volvulus is intermittent chronic malabsorption may have children by congestion and edema, constipation, diarrhea and vomiting. Sequelae include ischemia, mucosal necrosis, intramural air forming, gram-negative sepsis, perforation, peritonitis and death.
The adult volvulus can occur due to the clamps: postoperative, postinflammatory, congenital intestinal neoplasia, mesenteric retractable.
Strangulation can involve both the colon as well as thin instetinul and has at least two points of occlusion, realizing a closed loop in which the ischemic lesions often leading to gangrene is installed. It installs the evolving Joint shock: hypovolemic and septic. The lumen is closed loop bottlenecks at both ends, bacteria multiply rapidly and andoluminale toxins pass into the peritoneal cavity where they are easily absorbed. These toxins are responsible for vascular events, pulmonary and peripheral. Toxemia and infection are faster and more serious is how much longer segment strangled.