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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