#Volvulus, sigmoid colon
Pert hx: Hx of multiple abdominal surgeries to repair a ventral incisional hernia. Hx of partial colectomy. Elderly pt. Hx of chronic constipation. CC: 4-week hx of non-bloody diarrhea and colicky type abdominal pain.
Pert PE:
Pert labs:
Pert Imaging/Studies: CT abdomen shows possible sigmoid volvulus.
DDx:
Tx:
-NPO for now. NGT if needed.
-Surgery consult: To evaluate if the patient has an acute abdomen requiring immediate surgery.
-GI consult: For evaluation and possible flexible sigmoidoscopy / colonoscopy for decompression of volvulus. Also, consider low-pressure barium enema for diagnostic
-C. diff toxin b/c of diarrhea.
-Pain management: Tylenol 650mg q4hrs, prn, for pain.
-Outpatient f/u with general surgery after discharge for consideration of possible procedure to prevent recurrence of volvulus.
How many cases play out: GI normally will come and consent patient for colonoscopy. They will go in and reduced the sigmoid volvulus bypassing the colonoscope to a level beyond the twist. In some cases, they will place a rectal tube that will be removed at the time of discharge. Patients often do well but need surgery f/u to evaluate for possible procedures to prevent recurrence of volvulus.