On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (On-Demand)

Video Transcription

Video Summary

Dr. Rohit Sharda reviews three causes of bowel obstruction: adult colonic intussusception, sigmoid volvulus, and acute colonic pseudo-obstruction (Ogilvie syndrome). Adult intussusception is uncommon and often has a malignant lead point; the featured patient underwent colonoscopy and successful surgical resection.<br /><br />For sigmoid volvulus, he explains key risk factors and CT findings, including the coffee-bean sign and mesenteric swirl. Endoscopic detorsion should use minimal or no insufflation and gentle manipulation. After detorsion, assess the mucosa for ischemia or necrosis and, when possible, leave a decompression tube. Larger drains or repurposed equipment may clog less than standard small-bore tubes. Endoscopic fixation may be considered for patients unable to undergo surgery, but recurrence is common without definitive treatment.<br /><br />Ogilvie syndrome is managed initially with supportive care: bowel rest, fluids, electrolyte correction, mobilization, and removal of contributing medications. If this fails, options include neostigmine—with monitoring and atropine available—or colonoscopic decompression with tube placement. Surgery is needed if ischemia, perforation, or deterioration occurs.<br /><br />The discussion emphasizes that endoscopic treatment is often temporary, especially for volvulus. Clear documentation, timely surgical involvement, and definitive management for suitable patients are essential.

Asset Subtitle

Rohit Sharda, MD

Keywords

bowel obstruction

adult colonic intussusception

sigmoid volvulus

acute colonic pseudo-obstruction

Ogilvie syndrome

endoscopic detorsion

neostigmine

colonic decompression