Hajj experience of general surgery department in al noor specialist hospital
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Hajj Experience of General Surgery department in Al-Noor Specialist hospital. Dr.Meshal Al-Harthy, MD Consultant General Surgeon. Dr.Mohammad Amin K Mirza Saudi Board of Surgery. April 2008. Case 1. 54 y.o Turkish, male

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Hajj Experience of General Surgery department in Al-Noor Specialist hospital

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Hajj experience of general surgery department in al noor specialist hospital

Hajj Experience of General Surgery department in Al-Noor Specialist hospital

Dr.Meshal Al-Harthy, MD

Consultant General Surgeon

Dr.Mohammad Amin K Mirza

Saudi Board of Surgery

April 2008


Case 1

Case 1

  • 54 y.o

  • Turkish, male

  • Sudden abdominal pain , at the umbilical area, for 4 hrs , severe in nature

  • Pt is in severe distress, tachepnic, & hypotensive

  • Abdomen:Skin is dusky. Soft lax , mild tenderness in umbilical region.


What is the next step

What is the next step?


Hajj experience of general surgery department in al noor specialist hospital

  • CXR: no free air

  • AXR: Dilated large bowel localized at Rt side.

    No leucocytosis


What to do

What to do??


Hajj experience of general surgery department in al noor specialist hospital

  • Whole small bowel gangrene?

  • Whole large bowel gangrene?

  • Part of small bowel & colon?

  • Ischemia of intestine &multiple small Gangrenous patches throughout the jejunum?


Risk factors of mesenteric vascular occlusion

Risk factors of mesenteric vascular occlusion

  • Atrial fibrillation

  • Low circulatory state( CHF, Shock)

  • Dehydration

  • Excessive exercise

  • Protein S defficiency


Case 2

Case 2

  • 23 y Saudi , male Pt

  • Sudden onset of sever abdominal pain & constipation

  • Generally stable, but in sever pain

  • Abdomen is distended , tender all over ,, with guarding


Next step

Next step !!!!


What management options we have

What management options we have?


Volvulus

volvulus

  • More common in men, occurringin 63.7% of men.

  • The average age at which sigmoid volvulus occurs in English-speaking countries is 60 to 65 years, although it tends to occur 15 to 20 years earlier in other parts of the world.

  • Black > White

  • Types:

  • Caecal

  • Transverse colon

  • Sigmoid


Colon resection

Colon Resection


Primary anastomosis or colostomy

Primary anastomosisorcolostomy?


On table lavage

On Table lavage


Sigmoid decompression and colopexy

Sigmoid Decompression and Colopexy

Salim AS. Management of acute volvulus of the sigmoid colon: a new approach

by percutaneous deflation and colopexy. World J Surg 1991; 15:68–73.


Mesosigmoidoplasty

Mesosigmoidoplasty


Foley catheter sigmoidostomy

Foley Catheter Sigmoidostomy


Hajj experience of general surgery department in al noor specialist hospital

T-Fasteners Sigmoidopexy

Gallagher et al.


Colopexy cecostomy

Colopexy & Cecostomy


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