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SPECIAL TYPES OF MECHANICAL INTESTINAL OBSTRUCTION Internal hernia Internal herniation occurs when a portion of the small intes - tine becomes entrapped in one of the retroperitoneal fossae or in a congenital mesenteric defect. The following are potential s...

Supportive management Nasogastric decompression is achieved by the passage of a non-vented (Ryle) or vented (Salem) tube. The tubes are normally placed on free drainage with 4-hourly aspiration but may be placed on continuous or intermittent suction. As well a...

TREATMENT OF ACUTE INTESTINAL OBSTRUCTION There are three main measures used to treat acute intestinal obstruction. Summary box 78.11 Treatment of acute intestinal obstruction /uni25CF /uni25CF /uni25CF /uni25CF John Alfred Ryle , 1889–1950, Regius Professor o...

TREATMENT OF ACUTE LARGE BOWEL OBSTRUCTION Large bowel obstruction is caused by an underlying carcinoma or less commonly diverticular disease and presents in an acute or chronic form. The condition of pseudo-obstruction should always be considered and exclude...

Treatment of adhesions Initial management is based on intravenous rehydration and nasogastric decompression; occasionally , this treatment is cura tive. Although an initial conservative regimen is considered appropriate, regular assessment is mandatory to ensu...

Treatment of caecal volvulus At operation the volvulus is frequently found to be ischaemic and needs resection. If viable, the volvulus should be reduced. Sometimes, this can only be achieved after decompression of the caecum using a needle. Further managemen...

Treatment of intussusception In the infant with ileocolic intussusception, after resuscitation with intravenous fluids, broad-spectrum antibiotics and naso gastric drainage, non-operative reduction can be attempted using an air or barium enema. Successful reduc...

Treatment of recurrent intestinal obstruction caused by adhesions Several procedures may be considered in the presence of recurrent obstruction including: /uni25CF repeat adhesiolysis (enterolysis) alone; /uni25CF Noble’s plication operation; Thomas Benjamin N...

Treatment of sigmoid volvulus Flexible sigmoidoscopy or rigid sigmoidoscopy and insertion of a flatus tube should be carried out to allow deflation of the gut. The tube should be secured in place with tape for 24 hours and a repeat radiograph taken to ensure th...

Vomiting The more distal the obstruction, the longer the interval between the onset of symptoms and the appearance of nausea and vomiting. As obstruction progresses the character of the vomitus alters from digested food to faeculent material, as a result of...

ANATOMY Surgical anatomy The rectum begins where the tinea coli of the sigmoid colon join to form a continuous outer longitudinal muscle layer at the level of the sacral promontory . The rectum follows the curve of the sacrum and ends at the anorectal junct...

BENIGN RECTAL LESIONS Endometrioma Endometrioma is rare and may be misdiagnosed as a carcinoma. The focus of the ectopic endometrial tissue produces either a constricting lesion of the rectosigmoid or a tumour invading the rectum from the rectovaginal septum....

Blood supply The superior rectal artery is the direct continuation of the inferior mesenteric artery and is the main arterial supply of the rectum ( Figure 79.1 ). The arteries and their accompanying lymphatics lie within the loose fatty tissue in the mesore...

CLINICAL FEATURES OF RECTAL DISEASE Symptoms Rectal diseases are common and can occur at any age. The symptoms of many of them overlap. In general, infl ammatory conditions a ff ect younger age groups, while tumours occur in the middle-aged and elderly . Summ...

Clinical features Carcinoma of the rectum can occur early in life, but the age of presentation is usually above 55 years, when the incidence rises rapidly . Often, the early symptoms are so insignificant that the patient does not seek advice for 6 months or m...

Diagnosis The anus should be inspected and the abdomen palpated. If abdominal rigidity or tenderness is present, early laparoscopy or laparotomy is indicated. A water-soluble contrast enema may help in delineating the injury , but a computed tomo- graphy (CT) ...

Differential diagnosis Many colorectal lesions can give rise to diagnostic di ffi culty . For example, it may be di ffi cult to distinguish an inflammatory stricture or amoebic granuloma on macroscopic appearance. Similarly , endometriomas, carcinoid tumours and so...

Endoluminal stenting An increasingly used alternative for patients with an obstruct - ing carcinoma is placement of an endoluminal stent, which can be done endoscopically , often with fluoroscopic guidance. This can be used either as a palliative procedure or ...