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Hajj Experience of General Surgery department in Al-Noor Specialist hospital

Hajj Experience of General Surgery department in Al-Noor Specialist hospital. Dr.Meshal Al-Harthy, MD Consultant General Surgeon. Dr.Mohammad Amin K Mirza Saudi Board of Surgery. April 2008. Case 1. 54 y.o Turkish, male

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Hajj Experience of General Surgery department in Al-Noor Specialist hospital

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  1. Hajj Experience of General Surgery department in Al-Noor Specialist hospital Dr.Meshal Al-Harthy, MD Consultant General Surgeon Dr.Mohammad Amin K Mirza Saudi Board of Surgery April 2008

  2. Case 1 • 54 y.o • Turkish, male • Sudden abdominal pain , at the umbilical area, for 4 hrs , severe in nature • Pt is in severe distress, tachepnic, & hypotensive • Abdomen:Skin is dusky. Soft lax , mild tenderness in umbilical region.

  3. What is the next step?

  4. CXR: no free air • AXR: Dilated large bowel localized at Rt side. No leucocytosis

  5. What to do??

  6. Whole small bowel gangrene? • Whole large bowel gangrene? • Part of small bowel & colon? • Ischemia of intestine &multiple small Gangrenous patches throughout the jejunum?

  7. Risk factors of mesenteric vascular occlusion • Atrial fibrillation • Low circulatory state( CHF, Shock) • Dehydration • Excessive exercise • Protein S defficiency

  8. Case 2 • 23 y Saudi , male Pt • Sudden onset of sever abdominal pain & constipation • Generally stable, but in sever pain • Abdomen is distended , tender all over ,, with guarding

  9. Next step !!!!

  10. What management options we have?

  11. volvulus • More common in men, occurringin 63.7% of men. • The average age at which sigmoid volvulus occurs in English-speaking countries is 60 to 65 years, although it tends to occur 15 to 20 years earlier in other parts of the world. • Black > White • Types: • Caecal • Transverse colon • Sigmoid

  12. Colon Resection

  13. Primary anastomosisorcolostomy?

  14. On Table lavage

  15. Sigmoid Decompression and Colopexy Salim AS. Management of acute volvulus of the sigmoid colon: a new approach by percutaneous deflation and colopexy. World J Surg 1991; 15:68–73.

  16. Mesosigmoidoplasty

  17. Foley Catheter Sigmoidostomy

  18. T-Fasteners Sigmoidopexy Gallagher et al.

  19. Colopexy & Cecostomy

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