DUBAI 6 October 2019: An elderly woman was brought to the emergency department of a hospital in Dubai with severe abdominal pain and distension which then progressed to persistent vomiting, loss of appetite and a worsening general condition.
Dr. Ghodratollah Nowrasteh, General Surgeon, Medcare Hospital Dubai ordered a CT scan which found her intestines had twisted and looped around itself (called a volvulus), having the potential of leading to intestinal obstruction and blood supply occlusion.
This was considered a life-threatening situation as the remaining intestines could die if it did not receive adequate blood supply and oxygen. Surgery would be complicated due to the patients age, multiple health conditions and overall fragile condition. Nonetheless, the patient was immediately taken to the emergency operation theater where the intestinal loops were corrected and freed from adhesions to restore blood flow.
Following the operation, the patient was transferred to the ICU, where she initially showed signs of recovery. However, after 3 days, abdominal pain and distension returned as the large intestines became blocked. the patient has a long history of intestinal problems which complicated recovery. The gastroenterology team was brought in, who performed a colonoscopic decompression procedure stenting the detected constrictive segment of the colon. The patient then recovered over the following days, and was sent for post-operative rehabilitation.
Volvulus of the intestines are rare but can lead to very serious, life-threatening situations if not diagnosed and treated in a timely manner. These cases run a very high risk of mortality. In adults, causes of volvulus of the intestines include an elongated colon, chronic constipation, infections, adhesions from previous abdominal surgeries as was the case with this patient. The intestines can become entangled due to adhesions that form after surgery, trauma or infections. The symptoms of volvulus appear suddenly and severely, so people usually go straight to the emergency room for prompt evaluation. These symptoms include severe abdominal pain, vomiting, nausea and constipation.
“This case was anything but straight forward – surgeries rarely go according to the text-book, as any well-seasoned surgeon will tell you! This patient had a very complicated medical history including hypertension and dyslipidemia, and she was not able to ambulate without assistance making the case very difficult” said Dr Nowrasteh. “Considering the patients age, condition and fragility, this surgery and subsequent treatment was particularly difficult requiring collaboration between the surgery and gastroenterology teams who worked with the utmost dedication and perseverance to quickly diagnose and manage the condition to ensure the optimal outcome and prevent complications”.