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    Colonic Volvulus: Disusun Oleh: Dhea Faizia Tasya (2110221036) Pembimbing: Dr. Yulia Rachmawati, Sp. Rad (K)

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    Dhea Faizia Tasya
    This document defines and describes colonic volvulus, which is the twisting of redundant colon around its mesentery. It is the third most common cause of colonic obstruction worldwide. The document discusses the types of colonic volvulus (sigmoid, cecal, transverse, splenic flexure), risk factors, clinical manifestations, diagnostic imaging findings, and management. Key points include that sigmoid volvulus accounts for 60-75% of cases and presents with asymmetric abdominal distention, while cecal volvulus occurs in 25-40% of cases and symptoms may intermittently resolve and recur. Plain abdominal x-rays may show the "coffee bean" sign in sigmoid volvulus or distention of a colon

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    Colonic Volvulus: Disusun Oleh: Dhea Faizia Tasya (2110221036) Pembimbing: Dr. Yulia Rachmawati, Sp. Rad (K)

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    Dhea Faizia Tasya
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    This document defines and describes colonic volvulus, which is the twisting of redundant colon around its mesentery. It is the third most common cause of colonic obstruction worldwide. The document discusses the types of colonic volvulus (sigmoid, cecal, transverse, splenic flexure), risk factors, clinical manifestations, diagnostic imaging findings, and management. Key points include that sigmoid volvulus accounts for 60-75% of cases and presents with asymmetric abdominal distention, while cecal volvulus occurs in 25-40% of cases and symptoms may intermittently resolve and recur. Plain abdominal x-rays may show the "coffee bean" sign in sigmoid volvulus or distention of a colon

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    Volvulus

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    This document defines and describes colonic volvulus, which is the twisting of redundant colon around its mesentery. It is the third most common cause of colonic obstruction worldwide. The document discusses the types of colonic volvulus (sigmoid, cecal, transverse, splenic flexure), risk factors, clinical manifestations, diagnostic imaging findings, and management. Key points include that sigmoid volvulus accounts for 60-75% of cases and presents with asymmetric abdominal distention, while cecal volvulus occurs in 25-40% of cases and symptoms may intermittently resolve and recur. Plain abdominal x-rays may show the "coffee bean" sign in sigmoid volvulus or distention of a colon

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    60 views25 pages

    Colonic Volvulus: Disusun Oleh: Dhea Faizia Tasya (2110221036) Pembimbing: Dr. Yulia Rachmawati, Sp. Rad (K)

    Uploaded by

    Dhea Faizia Tasya
    This document defines and describes colonic volvulus, which is the twisting of redundant colon around its mesentery. It is the third most common cause of colonic obstruction worldwide. The document discusses the types of colonic volvulus (sigmoid, cecal, transverse, splenic flexure), risk factors, clinical manifestations, diagnostic imaging findings, and management. Key points include that sigmoid volvulus accounts for 60-75% of cases and presents with asymmetric abdominal distention, while cecal volvulus occurs in 25-40% of cases and symptoms may intermittently resolve and recur. Plain abdominal x-rays may show the "coffee bean" sign in sigmoid volvulus or distention of a colon

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    Download as pptx, pdf, or txt
    of 25

    COLONIC

    VOLVULUS Disusun oleh:


    Dhea Faizia Tasya (2110221036)
    Pembimbing:
    Dr. Yulia Rachmawati, Sp. Rad (K)

    KEPANITERAAN KLINIK RADIOLOGI


    RSPAD GATOT SOEBROTO
    FAKULTAS KEDOKTERAN UPN VETERAN JAKARTA
    2021
    DEFINISI

    • Torsion or twisting of redundant


    segment of colon around its
    mesentery
    • Colonic volvulus, third most
    common cause of colonic
    obstruction worldwide, after
    colorectal cancer and complicated
    sigmoid diverticulitis

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    Intestinal volvulus
    Sigmoid volvulus
    Cecal volvulus
    Colon volvulus

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    TYPES

    Sigmoid Cecal
    01 60-75% of cases
    02 25-40% of cases

    Transverse Splenic flexure


    03 1-4% of cases
    04 <1% of cases

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    EPIDEMIOLOGI

    • Colonic volvulus paling sering terjadi pada colon sigmoid atau


    cecum

    Sigmoid volvulus
    • Usia 30-39 tahun
    Cecal volvulus
    • Wanita : pria = 4 : 1
    • Wanita ≤ 60 tahun
    • Pasien dengan diabetes
    • Wanita hamil (1% kasus cecal
    • Pasien dengan gangguan neuropsikiatri
    volvulus)
    • Wanita hamil
    • Jarang pada infants dan anak-anak

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    FAKTOR RISIKO

    • Konstipasi kronik
    • Dismotilitas kolon
    • Riwayat operasi abdominal  laparotomi
    • Riwayat episode volvulus
    • High-fiber diet
    • Frequent use of laxatives

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    ETIOLOGI

    • Colonic volvulus typically


    results from torsion of a
    redundant segment of colon
    along its mesenteric axis,
    occurring mostly commonly
    in sigmoid colon or cecum

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    MANIFESTASI KLINIS

    • Distensi abdomen
    • Nyeri abdomen Gejala sigmoid volvulus
    • Lower abdominal cramping • Asymmetric gaseous abdominal
    • Konstipasi distention associated with emptiness of
    • Obstipation left iliac fossa
    • Nausea, vomiting

    Gejala cecal volvulus


    Gejala pada anak-anak • Intermittent and/or spontaneously
    • Recurrent abdominal pain and bloody resolve and recur, or
    stools • Present acutely if intestinal obstruction

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    PEMERIKSAAN FISIK
    General Physical Rectal
    • KU, kesadaran, dan TTV • Feces +/-
    • Diaphoresis, hipotensi, takikardi, • Darah +/-
    demam

    Abdomen
    • Peristalsis +/-
    • Palpable abdominal mass
    • BU abnormal
    • Distensi

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    Atamanalp, S., 2010. Sigmoid Volvulus. The Eurasian Journal of Medicine, 42(3), pp.142-147.
    Mizumoto, J., 2021. Coffee Bean Sign Detected By Visual Inspection. The American Journal of Medicine, 134(6), pp.e388-e389.
    PEMERIKSAAN PENUNJANG

    Blood Test
    Imaging Studies
    - Darah lengkap
    • Foto polos abdominal (AXR)
    - Kadar elektrolit serum
    • CT or contrast enema imaging
    - Test fungsi renal

    Endoscopy
    Untuk menilai viabilitas colon, jika pada
    imaging perforasi (-) atau iskemia (-)

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    ABDOMINAL X-RAY OF SIGMOID VOLVULUS

    • large dilated loop of colon typically with air-fluid levels


    • 'coffee bean' sign
    • absence of rectal gas
    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    ABDOMINAL X-RAY OF SIGMOID VOLVULUS

    Herring, W., 2019. Learning radiology.


    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    ABDOMINAL X-RAY OF CECAL VOLVULUS

    • distention of loop of large bowel with long


    axis extended from right lower quadrant to
    epigastrium or left upper quadrant
    • single air-fluid level
    • cecal and small bowel dilation may be evident

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    ABDOMINAL X-RAY OF CECAL VOLVULUS
    ABDOMINAL X-RAY OF CECAL
    VOLVULUS
    BARIUM ENEMA OF SIGMOID VOLVULUS

    • typical “bird’s beak” appearance at the site of obstruction in sigmoid volvulus


    Patel, P., 2010. Radiology. West Sussex: Wiley-Blackwell.
    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    BARIUM ENEMA OF CECAL VOLVULUS
    CT OF COLONIC VOLVULUS

    • “whirl sign”

    Chen MYM, Pope TL, Ott DJ. Basic radiology. New York: Lange Medical Books/McGraw Hill, 2004.
    MANAGEMENT

    Initial supportive management


    • IV fluid Sigmoid Volvulus
    Non surgical
    • Dekompresi dengan sigmoidoskopi fleksibel
    Cecal Volculus dan memasukkan rectal tube past obstruction
    Non surgical Surgical
    • Detorsi dan dekompresi • Reseksi dan/atau anastomosis primer
    kolonoskopi • Indikasi: strangulasi, perforasi, atau
    Surgical dekompresi dengan endoskopi yang gagal
    • Right colectomy + ileotransvrse
    colonic anastomosis

    TRAN, C., CHEN, Y. A., SHAH, R., & VAISMAN, A. (2020). The Toronto notes 2020: comprehensive medical reference and review for the Medical Council of
    Canada Qualifying Exam Part 1 and the United States Medical Licensing Exam Step 2. Toronto, Toronto Notes for Medical Students, Inc.
    Suspect gangrene
    Suspect colon ischemia • Hipotensi dan syok
    • Sudden cramping • Hematokezia atau BAB berdarah
    • Nyeri ringan di LLQ merah
    • Urgent desire to defecate • Demam
    • Bright red or maroon blood in • Leukositosis
    stool in last 24 hours • Nyeri tekan abdomen
    • Bloody diarrhea • Somnolen
    • Metabolic acidosis

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    PROGNOSIS

    • SV memiliki prognosis yang baik


    • Mortalitas : 50%  10%
    • Adanya syok, bowel gangrene, perforasi kolon, komorbiditas, usia tua,
    dan emergency surgery meningkatkan mortality rate
    • Morbiditas : 6 – 24%

    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    THANK YOU
    DAFTAR PUSTAKA

    1. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record


    No. T115668, Colonic Volvulus; [updated 2018 Nov 30, cited place cited date here]. Available
    from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.
    2. Atamanalp, S., 2010. Sigmoid Volvulus. The Eurasian Journal of Medicine, 42(3), pp.142-147.
    3. Mizumoto, J., 2021. Coffee Bean Sign Detected By Visual Inspection. The American Journal of
    Medicine, 134(6), pp.e388-e389.
    4. Herring, W., 2019. Learning radiology.
    5. Patel, P., 2010. Radiology. West Sussex: Wiley-Blackwell.
    6. Chen MYM, Pope TL, Ott DJ. Basic radiology. New York: Lange Medical Books/McGraw Hill,
    2004.
    7. TRAN, C., CHEN, Y. A., SHAH, R., & VAISMAN, A. (2020). The Toronto notes 2020: comprehensive
    medical reference and review for the Medical Council of Canada Qualifying Exam Part 1 and the
    United States Medical Licensing Exam Step 2. Toronto, Toronto Notes for Medical Students, Inc.
    MANAGEMENT

    • Resusitasi cairan  fluid-electrolyte imbalance, nasogastric aspiration, dan


    parenteral feeding
    • Flexible endoscopic detorsion  tingkat kesuksesan 33 – 91%
    • Emergency surgery pada pasien dengan peritonitis, bowel gangrene, atau
    perforasi
    • Detorsion, sigmoidopexy, mesosigmoidoplasty, or sigmoid resection with
    primary anastomosis or stoma
    • After the resection of gangrenous segment, Hartmann's or Mikuliez procedures
    • Endoscopic decompression is the usual treatment for a sigmoid volvulus.
    • Sigmoid colectomy may be used to reduce or prevent recurrent volvulus.

    Herring, W., n.d. Learning radiology.


    DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115668, Colonic Volvulus; [updated 2018 Nov 30,
    cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T115668. Registration and login required.

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