Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Sigmoid Volvulus Sinoatrial Block 1349

management

What to Do First

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

General Measures

■Assess for presence or absence of peritoneal signs

specific therapy

■peritoneal signs absent

➣endoscopic reduction, decompression, and placement of a rectal

tube; mucosa assessed for viability

successful in 85%, recurs in 50%

bowel preparation and elective surgery should follow

reduction with Gastrograffin enema may be useful

■peritoneal signs present

➣urgent laparotomy

sigmoid resection, colostomy and Hartmann’s pouch in most

cases

primary anastomosis in selected cases

follow-up

■Return visits for recurrent symptoms if decompressed endoscopi-

cally

■Usual postoperative visits to ensure wound healing

complications and prognosis

■recurrence rate <1%

■mortality 10–30% with viable and 40–80% with non-viable bowel

SINOATRIAL BLOCK

EDMUND C. KEUNG, MD

history & physical

History

■Infarction and fibrosis of the atrium, excessive vagal discharge, acute

myocarditis, drugs such as beta blocker, calcium channel blocker,

clonidine, procainamide, quinidine. Most common in elderly (beta

blocker in ophthalmic solutions).