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)