Surgical management of colonic volvulus during same hospital admission

To study the local patient profile, diagnostic methods, and treatment outcome in patients with large bowel volvulus to recommend a management plan. A retrospective study of patients record with a final diagnosis of large bowel volvulus treated at King Saud Medical Complex, Riyadh, Saudi Arabia between January 2000 and December 2007 were performed for patient demography, clinical presentations, co-morbidity, diagnostic methods, anatomical types, management, and outcome. Forty-two patients with large bowel volvulus were reviewed. They represented 8.5% of all intestinal obstructions treated. Most had sigmoid volvulus [83%], were less than 60 years of age, and were male. Recognized risk factors were present in 12 [29%] patients. Diagnosis was suspected on plain abdominal x-ray in 28 patients [69%], although the characteristic signs of omega and coffee bean were seen in only 16 patients. Eight patients required emergency surgery. Endoscopic decompression was successful in 34 patients, followed by a definitive surgery in 24 patients. Seven patients refused surgery; 3 of them were readmitted with recurrence and were operated. Three patients were unfit for surgery. There were 3 deaths. Large bowel volvulus is uncommon in this area. Abdominal distension with pain, constipation, and characteristic gas pattern in plain x-ray can help diagnose most cases. Decompression can be achieved in most patients with sigmoid volvulus, followed by surgery during the same hospital admission. Transverse colon and cecal volvulus usually need emergency surgery

Management options in civilian anorectal injuries

This study aims to analyze our experience in the management of anorectal injuries with a particular reference to the use of rectal wall repair, diverting colostomy, distal rectal washout andpresacral drainage. The management of 26 patients with anorectal injuries treated at Riyadh Central Hospital, over an 8 year period [1997-2004] was reviewed. There were 15 patients with extraperitoneal injuries. Transrectal repair was possible in 12 patients, diverting colostomy was carried out in 7 patients, distal washout in 4, and none had formal presacral drainage. There were 8 patients with intraperitoneal injury. All were repaired through laparotomy, only 4 patients had diverting colostomy None were treated by either distal washout or presacral drainage. Three patients had an anal sphincter injury treated by sphincter repair and diverting colostomy and perineal drainage. There -was no mortality related to anorectal injuries in our study. We conclude that most anorectal injuries in our civilian practice are due to low velocity firearm injury or non firearm injury which produced less devastating injuries. Intraperitoneal rectal injury can be managed by rectal wall repair and that diverting loop colostomy should be performed only if there is gross peritoneal contamination. Extraperitoneal injury can be repaired if accessible, colostomy is indicated for high grade injury and if rectal wall repair is not possible. Most civilian rectal injuries can be managed without routine use of distal rectal washout and presacral drainage