Etiology of sigmoid volvulus, the most characteristic manifestation of sigmoid volvulus is:

It is one of the more common strangulated obstructions of the colon. The main reasons are that the sigmoid colon is lengthy and the mesangium is relatively short, or due to inflammatory adhesions. The loop of the colon rotates along the long axis of the mesangium with its mesangium as a fixed point, causing partial or complete occlusion of the intestinal lumen, which is called volvulus.

**: Excessive sigmoid colon, pelvic inflammation, adhesions, scarring, constipation, intestinal roundworm mass, Hirschsprung's disease, etc.

Typical symptoms: abdominal pain and progressive bloating. Clinically, it can be divided into subacute and acute fulminant types.

The subacute form is common, with a slow onset of abdominal pain, a history of irregular episodes of abdominal pain and a history of abdominal pain that disappears after defecation and gas; persistent mid-lower abdominal distension and pain, paroxysmal exacerbation, no defecation and gas; Nausea and vomiting are small, and late vomiting has a fecal odor. The acute explosive form is more common in young people, with an acute onset, rapid progression, severe diffuse pain in the abdomen, and early and frequent vomiting. Shock is predisposed to due to the loss of large amounts of body fluid.

Other symptoms: Shock symptoms such as decreased blood pressure and weak pulse.

Diagnosis is based on a history of chronic constipation with multiple previous abdominal pains. The onset was abrupt, with cramping, abdominal distension, vomiting in the left lower quadrant, and typical manifestations of low intestinal obstruction, suspected of sigmoid volvulus.

Physical examination shows obvious abdominal distention, palpable torsion of the left lower quadrant, and a torsion Z-shaped loop of huge flatulence on plain x-ray, and barium enema showing that the barium is blocked at the torsion, or is a "bird's beak" deformity, or a cone-shaped stenosis, and the diagnosis is confirmed.

Answer]: C sigmoid volvulus is more common in the elderly with constipation Sun Yunpai habits, the patient has persistent abdominal distension and rapid pain, abdominal distension is obvious and asymmetrical, stop gas, defecation, X-ray plain film can see a huge double-chamber inflated intestine is a loop, barium enema can be seen bird's beak changes.

Answer]: C sigmoid volvulus is common in the elderly in men, often constipation habits, manifested as: abdominal cramping, abdominal distention, low-pressure enema is often less than 500ml, that is, can no longer fissure perfusion, abdominal X-ray plain film shows a specific horseshoe-shaped huge double-chamber inflatable intestinal loop, standing position to see two liquid gas levels, barium enema to see torsion site of wanton barium obstruction, in the shape of a "bird's beak".

The sigmoid colon is long and the mesangium is short, and it is very easy to occur and permeate torsion, causing obstruction, which is divided into two types: non-closed loop and closed loop. The non-closed loop type presents with low colonic obstruction, and the intestinal flexure dilation spine is not severe; In the closed loop type, the sigmoid colon flexure is particularly enlarged, horseshoe-shaped, with the dome facing upward, some reaching the upper abdomen and diaphragm, and a large amount of gas and liquid in it; In the upright position, a large liquid level can be formed, and in the supine position, three tight lines of bending acres can be seen, which accumulate downward in the stricture, and these dense lines represent the sigmoid colon wall. Barium enemas may show barium obstruction proximal to the rectum or distal sigmoid colon, conical or "beak" narrow, with tips facing left or right, and if torsion is loose, barium may enter the closed loop of the bowel.

This is an open category on colon volvulus with 1 entry (including subclasses).

Volvulus of colon refers to the twisting of part of the intestinal loop with the mesocolon as the axis and the longitudinal axis of the intestine itself. The incidence varies in different regions, and there are more cases in Shandong and Hebei in China.

Colonic volvulus refers to closed loop intestinal obstruction caused by abnormal colon development, such as moving colon, transverse colon length, and sigmoid colon long, which is caused by the rotation of the long axis of the mesangium. Active cecum is the replacement of the extraperitoneal part of the cecum and ascending colon by a longer mesangium, which is free without fusion with the lateral peritoneum, and can move to the vicinity of the spine, divided into 3 degrees: the cecum is pushed to the right edge of the spine by one degree, the front of the spine is the second degree, and the left side of the spine is the third degree; The transverse colon or sigmoid colon can also be torsionally caused by the congenital length of the bowel and the relatively short mesangium.

In the setting of a sudden increase in colonic contents, especially if there is a sudden change in ** or an increase in abdominal pressure, an excessively long intestinal tube can be rotated clockwise or counterclockwise along the mesangium, causing mechanical intestinal lumen obstruction. It is generally considered that 180 degrees is physiological torsion, and most of them are simple intestinal obstruction; If the entire intestinal segment is torvulus to 360 degrees, it is usually strangulated. Colon volvulus is more common with sigmoid volvulus and is more common in older men.

Cecal volvulus is less common and can occur at any age, with a higher incidence in 20-40 years. Transverse colonic volvulus is rare if not caused by adhesions.

When the volvulus is severe, the abdomen is asymmetrically bulging and the intestinal loop without regular flatulence can be seen, and if it cannot be reduced in time, the flatulent intestinal loop can cause intestinal wall necrosis, perforation, peritonitis and even death due to intestinal strangulation.

The success rate of non-surgical ** colon volvulus is as high as 76% 92%, and the mortality rate and complications are lower than that of surgery**, but the pathological mechanism of torsion is not resolved, so the **post** rate is as high as 57%. The long-term outcome of non-surgical ** is still debated, and some scholars advocate that non-surgical ** should also be actively prepared for the whole body and bowel after recovery, and elective surgery** should be performed to remove the cause of torsion, unless the patient has contraindications to surgery. Non-surgical failure** or intestinal necrosis should be actively surgically surged**, and some patients with recurrent sigmoid volvulus obstruction can also be operated on immediately once diagnosed**.

During the operation, different surgical methods should be adopted according to the contamination of the intestinal tube and abdominal cavity.

Answer]: A sigmoid volvulus patients can see asymmetrical abdominal distension or intestinal type, abdominal tenderness hall coarse wisdom and muscle tension is not obvious, abdominal X-ray plain film can show horseshoe-shaped inflatable intestine ring, barium enema barium shadow tip is "beak" shape. In item A, vomiting occurs later in patients with sigmoid volvulus rather than early stool and is frequent, so the answer is A.

"What are the symptoms of rectosigmoiditis".

The onset is slow, mostly chronic, prolonged, and reciprocal, and a few have a sudden onset, showing a continuous progression or fulminant process.

Digestive manifestations: abdominal pain and diarrhoea are the most common, abdominal pain is located in the left lower quadrant, dull pain, colic, relieved after defecation. Diarrhoea is most commonly made in mucopus, bloody stools, ranging from several to 10 times a day, often with tenesmus. There are still nausea, vomiting, loss of appetite.

Systemic symptoms: anemia, emaciation, hypoproteinemia, water and electrolyte imbalances, mental anxiety.

Extraintestinal manifestations: often arthritis, erythema nodosum, chronic active hepatitis, oral ulcers, etc.

Left lower quadrant tenderness, and a cord-like thickened or spasmodic bowel may be palpable in some patients.

If there are complications, there are corresponding manifestations.

After the lesion is diagnosed, an enema is done every day, and then it will bleed again. What's going on? Could it be that the intestines were broken during an enema or colonoscopy?

Or is there something wrong with it? First of all, the probability of intestinal perforation caused by colonoscopy is very low, if the perforation is really ruptured, the patient has very obvious symptoms, and you do not belong to this situation. The cause of bleeding is considered to be due to the presence of lesions in the colon, and colonoscopy may cause local bleeding from lesions or hemorrhoids.

I don't understand why I went to an enema every day in the future, is it in **?

The key points in the diagnosis and treatment of volvulus generally include the following:

1. It is more common in the elderly with habitual constipation and a history of similar seizures in the past.

2. The clinical manifestations are acute abdominal pain, persistent abdominal pain, no gas and defecation, and obvious abdominal distension in the middle and lower abdomen.

3. During the physical examination, there was asymmetrical agitatory abdominal distention, there was obvious tenderness in the left lower abdomen of Jian Shu, the intestinal sounds were more active in the early stage of intestinal volvulus, and the intestinal volvulus led to strangulation and necrosis of the intestinal loop, and the symptoms of peritonitis or shock could appear.

4. Through the plain film of the abdomen, it can be seen that there is a huge double-chamber inflatable isolated intestinal loop on the left side of the abdomen, which goes straight from the pelvis to the upper or diaphragm. In general, the colon, transverse colon, and small intestine may have varying degrees of flatulence.

5. Through the barium irrigation enema, it can be seen that the barium fluid stops in the upper rectum, forming a typical bird's beak-like or spiral narrow.