Saturday, July 24, 2010

the other volvo

we all know about volvo cars - the swedish brand reknown for its (previously) boxy exterior & impeccable safety features. volvo is latin for "i roll", implying a circular movement or the rotation of wheels.

volvulus is a surgical condition in which a loop of bowel twists upon itself, causing a life-threatening obstruction. this usually present with acute abdominal pain with distension & constipation. a 55-year-old had just that this week. she looked like she has a twin pregnancy, such was the degree of abdominal distension, & she was obviously in distress over it.







the pre-op xray was confirmatory of the diagnosis - the Xs delineates the twisted & distended loop of bowel.














on opening the abdomen, the offending loop virtually popped out of the incision. the bowel distension was a result of trapped gas.











a small puncture (left) was deliberately made to release the gas. 
















the bowel subsequently deflated, like a leaking balloon. the loop of bowel was carefully untwisted & the operation concluded. the patient recovered completely.












it could have been worse had there been an obstruction of blood supply to the affected bowel, causing gangrene, rupturesepsis. a delay of one day would have resulted in a totally devastating outcome.

no one knows for sure why volvulus occurs & it's certainly nothing we can do to prevent it. it just happens & it's important to realise that persisitent abdominal pain requires immediate medical attention.

given the choice, i'd rather have volvo the car.

18 comments:

Mei Teng said...

That abdomenal balloon is not a very nice sight..hehe :)

I like Volvo cars.

missyc said...

oh dear what a bloating sight..the gas no smell doc? glad she recovered :D

ilene said...

Huyoh...that's a giant loop! Poor lady must have suffered and felt heavy all these time!

P/s: As a consolation, she's got a beautifully well spaced spine though! :)

doc said...

Mei Teng,

yes, it's not a pretty sight & i'd rather admire a volvo!

doc said...

Ilene,

she did suffer immense pain for some time before coming to hospital. i doubt if she realised or apprciated that she had "beautiful well-spaced spine."

doc said...

MissyC,

the gas was released via a small puncture & suctioned out, as seen on the left of the picture, so the OT was spared the foul odour.

zewt said...

that is really nasty... really really nasty...

anastasia said...

how come it doesn't pop like a balloon?

doc said...

Zewt,

it's something you only wished on your worst enemies.

doc said...

Anastasia,

it will, given time.

JoMel said...

eeuuw!! That's a disturbing sight! But informative. :)

doc said...

Jo,

sometimes, it's better not know the truth, don't you think?

Unicorn Girl said...

i hope she recovers soon . is this a new finding of sickness ? Usually when it's a stomach tumour then the stomach bloats - rite ?

doc said...

UG,

she recovered completely & is out of hospital.

this is just an unusual case of intestinal obstruction, which is more often caused by a tumour.

fishtail said...

At first sight, I thought that was a plastic model we see in the labs :)

doc said...

Fishtail,

this is as real as it gets!

Anonymous said...

EEEEEEEEUUUUUUUUUWWWWWWWWWW, that just raises my hairs!

No slightest clue behind volvulus?

Dear Doc, may I inquire about the constant abdominal pain? It happens with a pattern, starting from mid month. It always begins first with constipation. After the constipation is dealt with, the pain just doubles and persists for a week. Am I a weak stomach suspect?

doc said...

Anonymous,

in this case, the volvulus just occured without obvious cause.

about your abd pain - it's a very brief description so i can't comment further except that since it follows a cycle, it's unlikely to be related to your stomach or bowel. it's best you consult a gynae who will be able to give you a proper examination, incl an ultrasound.