Bowel Perforation and Volvulus
from EM Clerkship Hosted by Zack Olson, MD
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)
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