Treatment

Treatment

Abscesses less than 5 /uni00A0 cm in diameter normally resolve with intravenous antibiotic treatment. As antibiotics take e ff ect, the magnitude of the swinging pyrexia can decrease with each successive spike in temperature. Serial monitoring of C-reactive protein levels is useful to non-invasively monitor response to treatment. Abscesses greater than 5 /uni00A0 cm require either percutaneous aspiration/drainage or surgical intervention. If percutaneous radiological approaches fail, then operative washout is indi cated. This can be conducted laparoscopically (laparoscopic vage) or via an open approach. The technical challenges la involved are such that this should only be undertaken by an wel may be matted and di ffi cult experienced surgeon. The bo to separate in order to access the abscess. All regions of the peritoneal cavity should be accessed, with a view to drainage of any residual collections. The entirety of the small intestine and adjoining mesentery should be exposed to ensure that there are no residual interloop abscesses. If a phlegmon is appar ent, then only in the setting of life-threatening circumstances should the components of this be separated. Treatment

This is normally supportive. Viral mesenteric adenitis normally resolves spontaneously but can recur. The symp toms in bacterial mesenteric adenitis include cramping pain, vomiting and diarrhoea. They can be severe and require hospitalisation. Treatment

Sigmoid volvulus can be quickly reversed with endoscopic decompression, but recurrence is common. Most patients will ultimately require surgery to resect the intestine and adjoining mesentery . These patients often have multiple comorbidities and present challenging anaesthetic and ethical dilemmas (see Chapter 77 ).

Malrotation Intestine aligned Sehgal R (eds). Mesenteric principles of gastrointestinal