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A Z.of.Emergency.radiology.3HAXAP

A Z.of.Emergency.radiology.3HAXAP

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Published by: shah_alina92 on Aug 13, 2011
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05/22/2012

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Left renal tract obstruction secondary to a left vesico-ureteric calculus
(arrowhead).

Unenhanced renal tract CT. This demonstrates an obstructing calculus in
the upper third of the left ureter.

Characteristics

Occurs when the sigmoid colon rotates causing a closed loop obstruction.
Vascular compromise may occur.Predisposed in patients with a redundant
sigmoid loop and a narrow mesentery.

Likely to be related to chronic severe constipation.

Occurs in the elderly and in patients with severe psychiatric or neuro-
logical diseases.

Clinical features

Patients will often present late and provide a poor history.Suspect in the
elderly or senile patients with obstruction.

Crampy lower abdominal pain with associated distension is common.

Absolute constipation and tenesmus (secondary to rectal traction).

Similar episodes in the past are often described, often self-terminating
following passage of a motion.

Beware signs of sepsis as these indicate likely gangrene. Perforation is
uncommon.

Radiological features

On plain abdominal films, look for a loop of large bowel extending
upwards from the pelvis.Described as a‘coffee bean’appearance.

Barium studies can be performed as long as gangrene is not suspected.
The barium characteristically tapers in the shape of a bird’s beak.

A whirled pattern has been described on CT.This is formed from the
twisted afferent and efferent loops of bowel.

Management

Fluid resuscitate and correct electrolyte disturbances.

Gastric and intestinal decompression with a NG tube is indicated.

Broad spectrum antibiotics.

Consult the surgical team as early decompression via a sigmoidoscope
and flatus tube may prevent ischaemic complications.

Surgical resection necessary if conservative decompression fails.

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