Bowel Perforation and Volvulus

Bowel Perforations











History











Perforation takes time, frequently symptoms were either ignored or not noticed as can occurring in…











* Elderly, diabetic, or immunosuppressed patients (frequently have minimal symptoms)* Pediatric patients (unable to or scared to mention symptoms)











Exam











Commonly have “peritoneal signs”











* Guarding* Rebound Tenderness* Rigidity











Testing











* CT Scan* X-Ray? (not your primary test, but a common test question will show you an upright chest X-ray and you will see a rim of free air under the diaphragm (should NOT be there in a normal upright X-ray)











Treatment











* Broad spectrum antibiotics* Stat surgical consult











Volvulus











It is common to first learn this as a pediatric condition (Malrotation with Volvulus) however it is common in adults as well. The two most common subtypes are…











* Cecal Volvulus* Sigmoid Volvulus











The history exam and testing plan is the same as with bowel obstruction. The primary difference is that volvulus without ischemia/gangrene is frequently treated with colonoscopy which is a GI CONSULTATION rather than surgical consultation.











Additional Reading











* Management of colonic volvulus (PubMed)