c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

The Acute Abdomen: 16

A D V E R T I S E M E N T

   
 

Inflammatory bowel disease may present with acute abdominal pain. Crohn’s (see recurrent Crohn's disease) may result in acute or chronic obstruction, perforation and abscess. Terminal ileitis may be a separate entity that mimics appendicitis, and may be self-limited rather than chronic like Crohn’s. Ulcerative colitis (see ulcerative colitis) and colonic Crohn’s may lead to toxic megacolon, which may become a dire surgical emergency if the patient doesn’t rapidly respond to massive steroids.     

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The Acute Abdomen: 17

A D V E R T I S E M E N T

   

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Colonic dilatation from obstruction, most commonly a left-sided cancer (see obstructing colon cancer) in an older patient, can lead to cecal perforation when the cecum exceeds 11-13 cm in diameter. A cancer may also perforate directly (see perforated sigmoid carcinoma.) Unresponsive infectious colitis may also become a surgical emergency. Ischemia, most commonly left sided, may ensue after pump bypass or myocardial infarction because of low flow. Such conditions often resolve with non-operative management. Inferior mesenteric artery sacrifice during aneurysm surgery may also lead to ischemic colitis. Colon resection may become necessary if the bowel loses viability.  

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The Acute Abdomen: 18

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Mechanical colon obstruction can result when a mobile portion of colon, usually sigmoid (see sigmoid volvulus), less commonly cecum (see cecal volvulus and cecal volvulus (video)) twists or folds (see cecal bascule) on itself. The resulting closed loop can become massively distended, lose its blood supply and/or perforate. Volvulus is an acute abdominal emergency. Sigmoid volvulus can sometimes be reduced by colonoscopy or hydrostatic enema pressure. Intussusception, often iliocecal, in adults is usually associated with a lead point such as a pedunculated polyp (see intussuscepting cecal carcinoma.) 

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This page was last modified on 4/28/2006.