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

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

9. What to do??

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

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

12. 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

13. Next step !!!!

16. What management options we have?

21. 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

22. Colon Resection

23. Primary anastomosis or colostomy ?

24. On Table lavage

26. 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.

27. Mesosigmoidoplasty

28. Foley Catheter Sigmoidostomy

29. T-Fasteners Sigmoidopexy Gallagher et al.

30. Colopexy & Cecostomy