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Colonic ischemia - Coggle Diagram
Colonic ischemia
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Acute Appendicitis
appendix:
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postion
If rotation does not occur, resulting in a pelvic, subcaecal or paracaecal position.
Occasionally, the tip of the appendix becomes extraperitoneal, lying behind the caecum or ascending colon (more difficult to remove, especially laparoscopically)
Rarely, the appendix can be found near the gall bladder or, in the case of intestinal malrotation, in the left iliac fossa
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appendicular artery is an end-artery, thrombosis results in necrosis of the appendix
emergency
obstruction of fecolith or enlarged lymphoid nodules cause bacterial proliferation and invasion of the appendix wall
pain: RIGHT GROIN first: periumbilical (T10)then Right iliac fossa (irritation of parietal peritoneum )
psos sign (pain on passive extension of the right thigh) or Obturator sign (pain on passive internal
rotation of the hip when the right knee is flexed)
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Ileal Diverticulum (Meckel diverticulum)
out-pouch of ilium 
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Free (74%) or attached to the umbilicus (26%).
Anomalies between the diverticulum and umbilicus may include the presence of fibrous cord, cyst, fistula or sinus
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rule of 2:
2% of population
2 feet proximal to the ilocecal valve
2 inches
2 ectopic tissue (gastric and pancreatic)
2 yrs at clinical presentation
Rectal prolapse
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Children: follow severe attack of diarrhoea,
from loss of weight and consequent loss of fat in the ischiorectal fossa, neurological disorder, or Hirschsprungs disease.
Adult: often associated with third-degree haemorrhoids,
when it is referred to as mucohaemorrhoidal prolapse.
In the female, a torn perineum, and in the male straining from urethral obstruction
In old age: both mucosal and full-thickness prolapse are associated with weakness of the sphincter mechanism
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Bowel obstruction
Ilocecal valve fxn: prevent back flow of chyme and prevent contamination of small intestine with colonic bacteria side note:
In distal obstruction iliocecal valve may open allow fecal matters to inter small intestine (fecal vomiting)
iliocecal valve Common site for intussusception (ileum go inside the colon )
Intestinal obstruction
Mechanical: foreign body or fecal impaction (intraluminal) cancer (mural) mass adhesion and embryologic band (extrinsic compression)
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large bowl obst.
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Large bowel obstruction may require an urgent operation to remove the obstructing lesion,
or a temporary bypass procedure (e.g., defunctioning colostomy).
Small bowel obst.
oTypically caused by:
Postoperative adhesions (important to ask in history) e.g., previous appendectomy).
o Hernias obstruction (e.g., inguinal),
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Intestinal malrotation
embryo
6th week- physiologic midgut herniates through umbilical ring
10th-12th week-returns to abdominal cavity + rotates around superior mesenteric artery (SMA), total 270° counterclockwise
in Intestinal malrotation this process fails; small bowel is found predominantly on right side of the abdomen, cecum is displaced into the epigastrium - right hypochondrium, ligament of Treitz is displaced inferiorly and rightward fibrous bands (of Ladd) course over the horizontal part of the duodenum (DII), causing intestinal obstruction.
predisposes to midgut volvulus .cuz
Has narrow base for the small bowel mesentery
Malrotation with volvulus is life-threatening.
presents with bilious vomiting (Bile-stained or bilious vomiting in the infant is a sign of intestinal obstruction until proved otherwise)
gut strangulates passing of bloodstained stools and pt
becomes progressively sicker
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Diverticular disease
multiple colonic diverticula (outpoutching), predominantly throughout the sigmoid colon, though the whole colon may be affected
The sigmoid colon has the smallest diameter of any portion of the colon and is therefore the site where intraluminal pressure is potentially the highest.
when the neck of the diverticulum becomes obstructed by feces and becomes infected.
The diverticula can perforate to form an abscess in the pelvis
Colon mobilization
To mobilize you need to incise in the white line of Toldt and to take care of posterior relations then mobilize medially to secure vessels. The white line of Toldt is the avascular plane for incision and is the anterior confluence of the colonic visceral peritoneum with the parietal peritoneum of the lateral abdominal wall
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Volvulus
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Results from adhesion, internal hernia or twisting of intestine e.g., Volvulus of sigmoid colon
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