Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Cecal Volvulus Celiac Sprue and Malabsorption 289

tests

■abdominal X-ray: dilated loops of small bowel with air/fluid levels

(small bowel obstruction)

■dilated air filled cecum projecting from the right lower quadrant to

the left upper quadrant

■Gastrograffin enema: abrupt blockage at the torsion point

■abdominal CT scan can be diagnostic

differential diagnosis

■Small bowel obstruction

■Ileus

management

What to Do First

■Confirm diagnosis with abdominal X-ray, barium enema or

CT scan

General Management

■Assess patient for comorbidities and suitability for surgery

specific therapy

■urgent laparotomy to reduce volvulus and fix the cecum

■right hemicolectomy if gangrene or perforation is present

■reduction and placement of cecostomy tube has high complications

rates from the cecostomy tube and a higher recurrence rate (20%)

follow-up

■Usual postoperative visits to ensure wound healing

complications and prognosis

■Mortality 15% with viable and 40% with non-viable bowel

Celiac Sprue and Malabsorption.........................

GARY M. GRAY, MD

history & physical

History

■Fatigue; abdominal bloating, distention and borborygmi; large vol-

ume, loose and malodorous stools; anorexia; weight loss

■Family history of growth failure, celiac sprue or malabsorption