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

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

  • 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?


  • CXR: no free air

  • AXR: Dilated large bowel localized at Rt side.

    No leucocytosis


What to do??


  • 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

  • Atrial fibrillation

  • Low circulatory state( CHF, Shock)

  • Dehydration

  • Excessive exercise

  • Protein S defficiency


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 !!!!


What management options we have?


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


Primary anastomosisorcolostomy?


On Table lavage


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


Foley Catheter Sigmoidostomy


T-Fasteners Sigmoidopexy

Gallagher et al.


Colopexy & Cecostomy


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