Strangulated Hernia, Dɔgbo ƒe Ʋuʋu Kpekpe, Kple Dɔgbo ƒe Ʋuʋudedi¶

Adɔgbo ƒe xexe sesẽ (dɔgbo sue alo gã ƒe mɔ̃ si xea mɔ keŋkeŋ alo eƒe akpa aɖe), strangulated hernia (dɔgbo ƒe ka si xaxa ɖe akɔta alo ƒodo ƒe gli ƒe ʋuʋu me sesĩe ale gbegbe be eƒe ʋu tsia), volvulus (dɔgbo ƒe ka si trɔna dzidzenu 180 va ɖo 360 ƒo xlã eya ŋutɔ ƒe ʋukawo), kple acute mesenteric ischemia (ʋu ƒe sisi kpata alo ʋukawo ƒe xexe si tsoa ʋu ƒe sisi yi dɔgboa me, si woyɔna zi geɖe be "dzidɔ si le dɔgboa me") nye amekoko kpata siwo xɔa ɣeyiɣi. Ne wonya tso ʋu si yia dɔgbo sue alo gã ƒe akpa aɖe me ko la, ememe lãkusi (mucosa) dzea kuku gɔme le gaƒoƒo 2 va ɖo 4 me, eye full-thickness gangrenous bowel necrosis and perforation dzɔna le gaƒoƒo 6 me, si naa aɖuɖɔ me dɔlékuiwo kple lactic acid ƒua gbe ɖe ʋukawo kple ƒodo me.

Wò agbanɔamedzi enumake ne wosusu be ʋuka si me ʋu sina tona, dɔgbo ƒe xexe, ʋuʋudedi, alo dɔgbo ƒe ʋu ƒe sisi le ame ŋue nye be wòalé ŋku ɖe akɔta, ƒodo, kple amekoko ƒe abi xoxowo ŋu be woakpɔ ʋuʋudedi sesẽ, fafɛ, si dzi womate ŋu aɖe o (strangulated hernia), mègatutu ("ɖe") ɖa sesẽe gbeɖe o trɔ yi ƒodoa me (si tua dɔgbo kuku, si nye gangrenous la ɖe ƒodo ƒe do me), de dzesi tetrad si wonya nyuie si nye ƒodo ƒe vevesese si nye colicky, ʋuʋudedi enuenu (trɔtrɔ amadede dzẽ/bilious alo dark brown/fecal), ƒodo ƒe keke, kple ŋutete manɔamesi be wòato gas alo aɖuɖɔ me (obstipation), mègana naneke kura to nu me o eye màna aɖuɖɔtoe alo enemas, eye nàƒo ka na atikewɔƒe siwo kpɔa nudzɔdzɔ kpatawo gbɔ enumake.

Wɔ esia fifia¶

1. Ƒo ka na atikewɔƒe siwo kpɔa nudzɔdzɔ kpatawo gbɔ enumake: Ƒo ka na wò nutoa me xexlẽdzesi kpata (911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia) alo nàlé ŋku ɖe míaƒe nyatakakadzraɖoƒe si nye xexlẽdzesi siwo wozãna kpata ne ame aɖe ƒe ƒodo me vevesese sesẽ aɖe kpe ɖe eŋu kple ƒunukpeƒe sesẽ aɖe si le veve sem le eƒe akɔta alo ƒodo me si magatrɔ ayi eme o**, vevesese si trɔ tso ƒutsotsoe siwo le ʋuʋum gbɔ va zu vevesese si nɔa anyi ɖaa, si le veve sem, ƒodo me vevesese kpata 10/10 si mesɔ kple alesi ƒodoa fa miamiamia o, amagbe (bilious) alo aŋutiɖiɖi vivi si ʋẽna lilili (feculent) vomit, ƒodo si le ʋuʋum kabakaba abe kpẽ ene, alo taɖuame, tɔtɔ, dzoxɔxɔ, kple dzi si le du dzi.
2. Kloe eye nàlé ŋku ɖe akɔta, ƒodo, kple amekoko ƒe abi siwo le ʋuka si me ʋu sina tona me ŋu: Dɔnɔ geɖe (vevietɔ ame tsitsiwo kple vidzĩwo) siwo ƒe dɔgbo xe mɔ na wo menya be woƒo dɔgbo ƒe ka sue aɖe ɖe aɖuɖɔtoe (akɔta), afɔkpodzi (akɔta ememetɔ si le etame), vidzidɔ (ƒodo ƒe abɔta), alo aɖuɖɔtoe si wotso me o. Kpɔ ɖa eye nàse le ɖokuiwò me blewuu be yeakpɔ ƒunukpeƒetetedɔ ɖesiaɖe si le teteɖeanyi, si le ʋeʋẽm.
3. MÈGAtutu ʋuʋudedi si le veve sem, dzĩ, aŋutiɖiɖi, alo esi xaxa ɣeyiɣi didi aɖe la dzi sesẽe GBEÐE o: Ne ʋuʋudedi ƒe ʋuʋudedi va zu fafɛ ŋutɔ, si sesẽ abe kpe ene, dzoxɔxɔ, dzĩ, aŋutiɖiɖi, alo blɔ-yibɔ, alo wòdo go wu gaƒoƒo ʋɛ aɖewo kple ʋuʋudedi alo dzoxɔxɔ la, mègadze agbagba be yeagbugbɔe aƒo ɖe eme o. Ne wozi dɔgbo ƒe ka si woƒo, si me gangrenous le dzi trɔ yi ƒodoa me ("reduction en masse") ɣlaa dɔgbo kuku, si doa do ɖe ƒodoa me eye wòwua ame kabakaba.
4. Mègana naneke kura to nu me o (NPO: tsi zero, nuɖuɖu zero, atikekui siwo woano zero): Ne wotsɔ mɔ̃ xe dɔgboa la, nusianu si womi la ƒoa ƒu ɖe nusi xe mɔa dzi, kekea dɔgbo ƒe gli si mebɔbɔ o la ɖe enu wògogo be wòagbã, eye wòhea projectile vomiting sesẽ kple feculent aspiration pneumonia si wua ame vɛ.
5. Strictly forbid all laxatives, stool softeners, fleet enemas, and prokinetic drugs: People with an acute bowel obstruction often assume they just have "bad constipation" because nothing is coming out. Atike si doa ŋusẽ aɖuɖɔtoe nono alo enema dodo ɖe mɔ̃ si xe mɔ na dɔgbo alo volvulus ŋu nana be dɔgbo ƒe ʋuʋu sesẽ si ƒoa do to dɔgbo si xe mɔ na me (stercoral alo ischemic perforation).
6. Nɔnɔme ɖe axadzi (nɔnɔme si me nàhaya) alo ne èkɔ ta ɖe dzi eye klowo nabɔbɔ: Esi wònye be tuɖedzi ƒe ʋuʋudedi kpata, si me agbagbadzedze aɖeke mele o nye dɔgbo ƒe xexe ƒe dzesi ta la, na tsize gã aɖe nanɔ dzadzraɖoɖi eye nàna dɔnɔ si le alɔ̃ dɔm alo le ʋuʋum la nanɔ woƒe axadzi ale be dɔgbo me tsi viviti mate ŋu age ɖe woƒe lãkusiwo me o. Ne wofɔ eye womele ʋuʋum vevie o la, na woagbɔ ɖe eme eye nàkɔ ta ɖe dzi dzidzenu 30 eye nàtsɔ akɔtaɖonu aɖo woƒe klo siwo wobɔbɔ la te be wòaɖe teteɖeanyi ɖa le ƒodo ƒe gli si le sesẽm la ŋu.

flowchart TD
    Start["Ƒodo Vevesese Sesẽ, Ʋuʋudedi, Ʋuʋudedi/Keke, Gas Mate ŋu Ato Ame Ŋu, alo Akɔta/Ƒodo ƒe Ƒuƒoƒo"] --> CheckHernia{"1. Kpɔ Akɔta, Akɔta ƒe Kpekpeme, Ƒodo ƒe Abɔta, Kple Abi: Ðe Hernia ƒe Ƒuƒoƒo Sesẽ, Falɛfalɛ, si Womate Ŋu Aɖe O Lia?"}
    CheckHernia -->|Yes| HerniaRule["MÈGATU Hernia Dzĩ, Aɖabɛ, Dzoxɔxɔ, alo Vevesese Agbugbɔ Age Ðe Eme O: Ƒo ka na 911 / 112 / 999 hena Amekoko Enumake"]
    CheckHernia -->|No Visible Hernia| CheckIschemia{"2. Kpɔ Ischemia / Volvulus Red Flags ɖa: Vevesese ɣesiaɣi, Vevesese 10/10 si mesɔ gbɔ o, Green/Fecal Vomit, Drum-Tight Belly, alo Shock?"}
    CheckIschemia -->|Yes| CallEMS["Ƒo ka na Dɔwɔƒe Kpata (911 / 112 / 999) Enumake: Gaƒoƒo 6 ƒe Fesre be Nàɖe Ischemic Bowel"]
    CheckIschemia -->|Cramping Waves Only| UrgentED["Tsɔe Yi Kɔdzi ƒe Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ Enumake hena CT Scan kple Nasogastric Decompression"]
    HerniaRule --> Protect["3. Strictly Nothing by Mouth (No Water/Food), MÈGANA Laxatives alo Enemas GBEÐE O, Takpɔ Yaƒoƒomɔ si le Axadzi ne Èle Ʋuʋum"]
    CallEMS --> Protect
    UrgentED --> Protect

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Reducible versus Incarcerated versus Strangulated Hernia: Alesi woawɔ ade dzesi vovototoa¶

ƒodo ƒe gli alo akɔta ƒe ʋuʋu dzɔna ne dɔgbo alo ƒodo me ami ƒe ka aɖe do to teƒe si gbɔdzɔ le lãmeka ƒe lãkusi me, zi geɖe le aɖuɖɔtoe (le akɔta ƒe ʋuʋudedi tame), afɔdzi ƒe mɔ (le akɔta ƒe ʋuʋudedi te tututu le ata ememetɔ si le etame, vevietɔ le nyɔnu tsitsiwo me eye wòtsɔa ka ƒe ʋuʋu ƒe agbɔsɔsɔme si kɔkɔ wu va ɖoa 30 va ɖo 40 le alafa me elabena afɔkpodzi ƒe asigɛa le kpuie eye wòsẽ), umbilicus (ƒodo ƒe abɔta), alo amekoko ƒe lãɖeɖe xoxo (incisional hernia).

Akpa etɔ̃ siwo me ʋuka me ʋu sina tona yia ŋgɔe gɔmesese le vevie elabena ƒunukpeƒetetedɔ ate ŋu atso esi me afɔku mele o ava zu esi ate ŋu ade ame ƒe agbe afɔku me le ŋdɔ ɖeka me:

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Dɔgbo Sue ƒe Mɔxexe (SBO) tsɔ wu Dɔgbo Gã ƒe Mɔxexe (LBO) kple Volvulus¶

Ne woxe dɔgboa ƒe mɔ̃a tso eme, le eƒe gli me, alo le gotagome nutete ta la, ya si womi, aɖuɖɔ, dɔgbo me acid, ʋumenugbagbeviɣi, kple dɔgbo me tsi (siwo zi geɖe la, tsi tsi lita 8 va ɖo 10 gbesiagbe le ame tsitsi si le lãmesẽ me gome) mate ŋu ato tɔa me o. Ke boŋ, tsi kple gas ƒoa ƒu ɖe mɔxenua tame, si kekea dɔgboa ɖe enu eye wòʋãa dzesi vevi 4 siwo nye dɔgbo ƒe xexe si wonya nyuie la:

1. Colicky (cramping) abdominal pain (si trɔna madzudzɔmadzudzɔe ne ƒoƒoe do mo ɖa)
2. Vomiting (kaba eye wòsɔa gbɔ le xexe gãwo me; tsi megbe eye wòʋẽna lilili le xexe suewo me)
3. Ƒodo ƒe keke (ʋuʋudedi kple ʋuʋudedi si le abe tympanic drum ene) .
4. Obstipation (ŋutete blibo be woato aɖuɖɔ alo flatus/gas me)

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Alesi woawɔ ade dzesii ne "Simple Obstruction" trɔ zu "Strangulated / Ischemic Bowel".¶

Le mɔ̃ bɔbɔe aɖe si xea mɔ na dɔgbo (si nye teƒe ɖeka si ʋuka siwo le dɔgboa me gakpɔtɔ le ʋuʋu ɖi) me la, kɔdzi ƒe nutete ɖeɖeɖa kple nasogastric (NG) tube kple tsi siwo wodona ɖe ʋuka me nana zi geɖe be amekoko megbe nusiwo léna ɖe wo nɔewo ŋu la ʋuna evɔ wometsoa ƒodoa o.

Gake le Closed-Loop Obstruction (afisi woƒoa dɔgbo ƒe akpa aɖe si wotu ɖe evea siaa ƒe nuwuwu le ɣeyiɣi ɖeka me, abe le hernia ƒe asigɛ me, le adhesion band te, alo le volvulus si wotro me ene) la, loop si xaxa la mate ŋu aɖe asi le eŋu ayi ŋgɔe ayi ɖe dɔgboa me alo agbugbɔe age ɖe dɔgboa me o. Nyaƒoɖeamenu si le ka si wotu la me dzina ɖe edzi, si tea ʋuka siwo le gli tsɛ siwo le dɔgboa me la gbã (ena ʋuka gã aɖe vuvuna le dɔgboa ƒe gli ŋu) eye emegbe wòtsoa ʋuka siwo me ʋu sina tona (strangulation).

Kpɔ dɔdaƒe ƒe aflaga dzĩ 5 siawo siwo fia be mɔxenu bɔbɔe aɖe tso ɖe dɔgbo si woƒo, si le kukum ŋu:

1. Vevesese trɔna tso ƒutsotsoe siwo nɔa ʋuʋum ɣeaɖewoɣi va zua vevesese ƔESIAƔI, si nu metsina o: Le mɔxenu gbãtɔ me la, vevesese va le aɖabaƒoƒo 3 ƒe ƒutsotsoe siwo le megbe me eye dometsotso siwo me vevesese mele o siwo fa miamiamia le wo dome. Zi alesi dɔgbo ƒe gli va zu ischemic alo ku la, vevesesea va zua eyia edzi, nu sẽna, eye meɖea asi le eŋu gbeɖe le ƒutsotsoewo dome o.
2. Dzesi siwo le dɔgboa me ƒe dzɔdzɔ (Dzɔdzɔenyenye, sesẽ, kɔdzi/akɔtave): Ƒodoa trɔna tso fafɛ kple fuɖename dzi va zua fafɛ kple sesẽ ne woka asi eŋu blewuu, kɔ akɔta, alo ƒoe (peritonitis ƒe dɔléle).
3. Systemic SIRS kple Sepsis dzesiwo: gbɔɖeme ƒe tachycardia (dzi ƒe tsotso atraɖii >100 va ɖo 110 le miniti ɖeka me), asrã yeye (>38.0 C / 100.4 F), gbɔgbɔ kabakaba, alo ʋu ƒe sisi ƒe ɖiɖi si womeɖe o.
4. Hematochezia (Ʋu, maroon, alo "currant-jelly" aɖuɖɔ): Ne dɔgboa ƒe lãkusi ememetɔ ʋuʋu le ʋu ƒe sisi ta la, dɔnɔa ateŋu ato ʋuʋudedi dzĩ, maroon, alo ʋu ƒe ʋuʋudedi tso dɔgboa me.
5. Kɔdzi ƒe nudokpɔƒe ƒe ɣlidodowo: Ʋu ƒe dzidziɖedzi serum lactate (>2.0 mmol/L), metabolic acidosis (bicarbonate / base deficit si le sue), kple ʋumenugbagbevi ɣiwo ƒe xexlẽme si dzi ɖe edzi ŋutɔ (>15,000 va ɖo 20,000/mm3).

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Dɔgbo ƒe nɔnɔme kpata vevi eve siwo mele be woato o: Acute Mesenteric Ischemia kple Pediatric Intussusception¶

1. Acute Mesenteric Ischemia ("Dzidɔ si le Dɔgboa Me" le Ame Tsitsiwo Me) .¶

Le acute mesenteric ischemia me la, ŋutilã me ʋuʋudedi alo abi ƒe xexe aɖeke menɔa anyi kura o. Ke boŋ ʋu si sina toa Superior Mesenteric Artery (SMA) (ʋuka gã ɖeka si naa dɔgbo sue bliboa kple dɔgbo ƒe ɖusime afã) me la, kasia:

• Arterial Embolism (50% of cases): Ʋu ƒe sisi si dona tẽ tso dzia ƒe miame le dɔnɔ aɖe si ŋu atrial fibrillation (dzi ƒe tsotso si mesɔ o), nyitsɔ laa dzidɔ, alo dzitodzito me dɔléle.
• Arterial Thrombosis (25% of cases): Cholesterol plaque ƒe ʋuʋu kpata le superior mesenteric artery ƒe gɔmedzedze le dɔnɔ si ŋu peripheral vascular disease le (amesi zi geɖe la, "intestinal angina" nɔa eŋu ɣleti geɖe: ƒodo ƒe vevesese si nu mesẽ o le miniti 30 le nuɖuɖu ɖesiaɖe ɖuɖu vɔ megbe kple vɔvɔ̃ na nuɖuɖu).
• Non-Occlusive Mesenteric Ischemia (NOMI, 20%) alo Mesenteric Venous Thrombosis (5%): Ʋukawo ƒe ʋuʋu sesẽ le shock/vasopressor zazã alo cocaine zazã me, alo ʋu ƒe sisi le mesenteric veins me le dɔnɔ siwo ŋu ʋu ƒe sisi ƒe kuxiwo alo ʋu ƒe sisi le ʋukawo me.

Acute Mesenteric Ischemia ƒe Dzesi Klasik: "Vevesese si Mesɔ Kple Lãmesẽdodokpɔ"

Le gaƒoƒo 2 va ɖo 6 gbãtɔwo (ne endovascular clot retrieval kpata alo bypass amekoko ate ŋu axɔ na dɔnɔa ƒe dɔgbo sue bliboa kokoko), dɔnɔa doa ɣli alo ʋuʋuna kple dɔgbo ƒe vevesese kpata, si nye afɔku gã 10/10 titina ƒodo, dɔgbo ƒe ʋuʋu sesẽ (ʋuʋudedi kple aɖuɖɔtoe kpata), ke hã ne dɔnɔdzikpɔla alo ɖɔkta ka asi woƒe ƒodo ŋu, ƒodoa se le eɖokui me be yefa keŋkeŋ eye ƒã hafi wòvivina. Nu ka ta? Elabena ischemia dzea egɔme tso dɔgboa ƒe ememe mucosal lining dzi, si ɖeko wòʋãa visceral pain nerves goglowo evɔ medoa dziku na gotagome parietal peritoneum o. Kaka ƒodoa nasesẽ eye wòasẽ (peritonitis) la, dɔgbo sue bliboa trɔ zu yibɔ eye wònye gangrenous xoxo, si tsɔ ku ƒe agbɔsɔsɔme si nye 60 va ɖo 80 le alafa me. Ne ame tsitsi aɖe alo amesiame si ŋu dzitodzito me ʋu ƒe sisi alo ʋukawo me dɔléle le la va le ƒodo me veve kpata, si le veve sem vevie kple ƒodo falɛfalɛ la, ƒo ka na 911 / 112 / 999 enumake eye nàbia tso atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ be woalé ŋku ɖe CT Angiogram (CTA) si le mesenteric arteries ŋu.

2. Ðeviwo ƒe Intussusception kple Vidzĩwo ƒe Midgut Volvulus (Le Vidzĩwo Kple Ðevi Siwo Le Azɔli Me) .¶

Le vidzĩwo kple ɖevi suewo gome la, amekoko ƒe dɔgbo ƒe nɔnɔme kpata eve siwo wowɔna kpata hiã be woade dzesi wo enumake:

• Intussusception (Ƒe ƒe agbɔsɔsɔme si woxɔna tso ɣleti 3 va ɖo ƒe 3, nusi gbɔ vidzĩwo/ɖevi siwo le zɔzɔm le ƒe dɔgbo ƒe xexe tso #1 me): Dɔgbo ƒe akpa ɖeka (zi geɖe la, ileum) kpɔa didiƒekpɔmɔ̃ le akpa si te ɖe eŋu (dɔgboa) me abe ŋkutsala si woate ŋu agbã ene, si xea mɔ na eƒe ʋu.
• Alesi woawɔ akpɔe: Vidzĩ si le lãmesẽ me doa ɣli zi ɖeka le aɖabaƒoƒo 15 va ɖo 20 ƒe ƒutsotsoe siwo me vevesese si nye colicky vevesese le me, hea klo eveawo siaa sesĩe va ɖoa woƒe akɔta eye wòtrɔna zua ɣie, emegbe edzudzɔa avifafa eye wòzua kuviatɔ nukutɔe, floppy, alo blukɔ hena miniti 20 va ɖo 30 hafi ɣlidodo ƒe ƒutsotsoe si kplɔe ɖo hits. Le gaƒoƒo ʋɛ aɖewo ko me la, ʋuʋudedi trɔna zua amadede dzẽ, àte ŋu ase ƒu si le abe soseti ene le ɖusime ƒodo me, eye vidzĩa ato "red currant-jelly stool" (ʋu dzĩ vivi si wotsaka kple sloughed mucus, si nye dɔgbo ƒe ʋu ƒe sisi ƒe dzesi si tsi megbe). Ne wolée le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ kaba la, keklẽŋusẽŋutinunyalawo ate ŋu atutu dɔgbo si wotsɔ didiƒekpɔmɔ̃ kpɔ la blewuu agbugbɔe aɖo teƒea le nɔnɔme 85 le alafa me me to ya bɔbɔe si me gbeɖiɖi sesẽwo fiaa mɔe alo tsi si me wodea tsii zazã amekoko aɖeke manɔmee.
• Vidzĩwo ƒe Tɔtrɔ Masɔmasɔ kple Midgut Volvulus (Vidzĩ Yeyewo Kple Vidzĩ Siwo Mexɔ Ƒe 1 O):
• Ðeviwo ƒe Sikase: Aɖuɖɔtoe dama (bilious) si le keklẽm le vidzĩ alo vidzĩ yeye me nye amekoko ƒe nɔnɔme kpata vaseɖe esime woaɖo kpe edzi be menye nenemae o. Ne vidzĩ si mexɔ ƒe 1 haɖe o ɖe ta alo ƒo tsi dama dama alo gbe dama viviti (menye no ɣi dzẽ dzẽ/formula curds o) la, woƒe dɔgbo sue bliboa ate ŋu atrɔ ƒo xlã mesenteric si le etame ʋuka (midgut volvulus), si ate ŋu agblẽ vidzĩa ƒe dɔgbo sue bliboa le gaƒoƒo 3 va ɖo 6 me. Yi ɖeviwo ƒe dɔléle kpata ƒe dɔwɔƒe si te ɖe ŋuwò tẽ alo nàƒo ka na 911 / 112 / 999 enumake.

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Kpekpeɖeŋunana gbãtɔ siwo wowɔna do ŋgɔ na kɔdziyiyi kple kɔdzi ƒe nuteɖeamedzi dzi ɖeɖe kpɔtɔ afɔɖeɖe ɖesiaɖe¶

Afɔɖeɖe 1: Ðoƒe si le dedie kple yaƒoƒomɔ̃wo takpɔkpɔ tso aɖuɖɔtoe me¶

1. Na dɔnɔa nanɔ NPO (tsi zero, tsikpe ƒuƒu zero, atike siwo woano zero): Tsi mililita 30 (ounce 1) gɔ̃ hã ate ŋu aʋã dɔgbo me tsi si ƒe amadede nye aŋutiɖiɖi, si ʋẽna lilili la ƒe geyser kpata le dɔnɔ si ƒe dɔgbo keke me.
2. Nɔnɔme si woatsɔ axe mɔ ɖe aspiration nu:
3. Dɔnɔ siwo ƒe dɔgbo xea mɔ ŋutɔ ate ŋu aʋuʋu dɔgbo me tsi si tsi anyi lita 1 va ɖo 2 le tsidzadza ɖeka si me agbagbadzedze aɖeke manɔmee me evɔ womaxɔ nuxlɔ̃ame si nye ʋuʋudedi dzro aɖe ko o.
4. Ne dɔnɔa le alɔ̃ dɔm, gbɔdzɔ, ame tsitsi, alo le ʋuʋum vevie la, na woamlɔ woƒe miame (si ƒe hayahaya ƒe nɔnɔme) eye nàtsɔ tsize gã aɖe aɖo woƒe asike te tututu.
5. Ne dɔnɔa le ŋudzɔ eye wòle ŋudzɔ kple ƒodo si keke vevie (abe sigmoid volvulus ene) la, anyinɔƒe le dzogoe si le tsitrenu afã si nye degree 30 va ɖo 45 dzi kple akɔtaɖonu siwo léa klo siwo wobɔbɔ ɖe te la ɖea nyaƒoɖeamenu si yi dzi ɖe akɔtaƒua ŋu dzi kpɔtɔna (si wɔnɛ be gbɔgbɔ nɔa bɔbɔe) esime wònana nuɖuɖutome la kɔ wu dɔgboa.
6. Beléle na hernia si wode gaxɔ me le ʋuɖoɖo me:
7. Na dɔnɔa namlɔ anyi gbadzaa eye woƒe akɔta kple klowo nabɔbɔ vie (eye ne woƒe akɔta ƒe ʋuʋudedi si wode gaxɔ me si **mexɔ dzo o, si ƒe amadede nye aŋutiɖiɖi, alo le veve sem haɖe o la, gbɔɖeme kpoo ɖe woƒe akɔta kple akɔta si wotsɔ lé akɔta vie ɖe akɔtaɖonu dzi ɖea nuheŋusẽ ɖa le akɔta ƒe asigɛa ŋu, eye ɣeaɖewoɣi la, enaa akɔta ƒe ʋuʋudedi si wode gaxɔ me kaba la trɔna le eɖokui si le dɔnɔdzikpɔʋu me).
8. Mègazi edzi sesĩe alo te asidɔwɔwɔ kpɔ le ɖokuiwò si gbeɖe o.

Afɔɖeɖe 2: Nusi dzɔna le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ¶

1. Vegbɔgbɔ Enumake To Ʋuka Me Kple Electrolyte Ðɔɖɔɖo: Dɔgbo si keke si xe mɔ na tsi, sodium, potassium, chloride, kple bicarbonate** lita 3 va ɖo 6 le dɔgboa ƒe ʋuka kple dɔgbo ƒe gli me, esime ʋuʋudedi enuenu hea hypokalemic, hypochloremic metabolic alkalosis (which tɔtrɔ yi lactic metabolic acidosis ne ischemia dze egɔme ko). Enumake ƒuƒoƒo siwo kpɔa nudzɔdzɔ kpatawo gbɔ dea IV-ka eve siwo me do gãwo le eye wotsɔa potassium kple magnesium ɖɔliɖɔli si woɖo taɖodzinu na la dea isotonic crystalloids me.
2. Nasogastric (NG) Tube Decompression: Dɔnɔdzikpɔlawo kple atikewɔlawo tsɔa Salem sump nasogastric tube falɛfalɛ si te ŋu trɔna bɔbɔe la toa ŋɔti me yia dɔgboa me blewuu eye wotsɔnɛ doa ka kple gli ƒe nu mimi si mebɔ o si nɔa anyi ɣeaɖewoɣi. Le sɛkɛnd 60 me la, NG-mɔ̃a ɖea gas si xaxa kple tsi viviti mililita 500 va ɖo 2,000 doa goe le dɔgboa me, eɖea ʋuʋudedi dzi kpɔtɔna ŋutɔ, eɖea ƒodo ƒe kekeme ƒe vevesese dzi kpɔtɔna, eye wòxea mɔ na ya si wua ame le CT scanning alo anesthesia induction me.
3. Contrast CT Scanning kple Nudede Nyawo Me Kakaɖedzitɔe:
4. CT Abdomen/Pelvis with IV Contrast (kple CTA ne wosusu be mesenteric ischemia): Fia milimeta tututu le "trɔtrɔƒe" afisi dɔgbo si keke la do go dɔgbo si mu, eye wòdea dzesi closed-loop twists, mesenteric swirl signs, kple bowel-wall blood perfusion nyuie o.
5. Endoscopic Detorsion for Sigmoid Volvulus: Ne dɔnɔ aɖe ƒe sigmoid volvulus si mebɔ o si me gangrene alo do aɖeke mele o le eŋu la, dɔgboŋutinunyala alo amekola ate ŋu ato sigmoidoscope si te ŋu trɔna bɔbɔe la ayi dɔgboa me le xɔ si me wowɔa dɔ kpata le me, aɖe sigmoid dɔgbo si ƒoƒo la ɖa eye wòaɖe asi le gas kple aɖuɖɔ si me tsi le ƒe duƒuƒu gã aɖe ŋu le aɖabaƒoƒo ʋɛ aɖewo ko me, kplɔe ɖo emegbe to amekoko me be woatsɔ tack down alo aɖe redundant loop la ɖa ale be magatrɔ gbeɖe o.
6. Emergency Laparotomy alo Laparoscopy: Ne strangulated hernia, cecal volvulus, closed-loop small bowel obstruction, alo acute mesenteric ischemia le eme la, amekolawo kplɔa dɔnɔa yia amekokoxɔa me tẽ le sika gaƒoƒo 6 ƒe fesre me be woaɖe asi le dɔgboa ƒe asigɛ si le tsia dzi la ŋu, aɖe dɔgboaa ɖa, agbugbɔ ʋu ƒe sisi aɖo anyi, eye dzra dɔgbo si ate ŋu anɔ agbe ɖo hafi wòahiã be woaɖe dɔgbo alo ostomy kotoku.

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Mɔ̃ɖaŋununya ƒe Dɔgbo ƒe Mɔxexe Kple Paralytic Ileus Kple Ogilvie Dɔléle (Aʋatso-Xɔxe) .¶

Menye dɔnɔ ɖesiaɖe si ƒe ƒodo keke, si vuvu eye eƒe dɔgbo megale ʋuʋum o la ƒe dɔgbo ƒe ŋutilã me ʋuʋu alo ʋuʋu le o. Le kɔdzi la, atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ kple amekolawo dea vovototo Mechanical Bowel Obstruction (si nye mɔxenu ŋutɔŋutɔ si hiã be woaɖe asi le dɔgboa ŋu alo awɔ dɔ na ame) kple Functional / Adynamic Ileus (afisi dɔgbo ƒe mɔ̃a ʋu gbadzaa, gake lãmeka gbadzaa ƒe gli la bu eƒe elektrikŋusẽ ƒe ƒodo ƒe ʋuʋu hena ɣeyiɣi aɖe):

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Dɔnɔ tɔxɛ siwo ƒe ŋutilã ƒe wɔwɔme trɔ: Ostomy blockages kple post-bariatric (Roux-en-Y) internal hernias¶

Dɔnɔwo ƒe ƒuƒoƒo eve siwo le dzidzim ɖe edzi kabakaba la doa go dɔgbo ƒe mɔxexe kpata ƒe ƒomevi tɔxɛ siwo me afɔku le ŋutɔ, siwo hiã be woanya nu tso eŋu etɔxɛe:

1. Ame siwo le agbe kple Ileostomy alo Colostomy ("Stoma Blockage") .¶

Le amesi ŋu ileostomy (dɔgbo sue si wotsɔ va ƒodo ƒe gli ŋu) alo colostomy le gome la, mɔ̃ ƒe xexe (zi geɖe la, nuɖuɖu siwo me ka le abe popcorn, mushroom, celery, koklozi ƒuƒu, nuku, alo atikutsetse ƒuƒu siwo vuvu le fascial exit ring, alo parastomal hernia gbɔe wòtsona zi geɖe) nye atikewɔwɔ enumake nudzɔdzɔ kpata:

• Nuxlɔ̃amedzesiwo le acute ostomy blockage ŋu:
• Dɔtɔ kpata le stoma ƒe dodo me hena wu gaƒoƒo 4 va ɖo 6 (vevietɔ le ileostomy me, si zi geɖe la, eɖea tsi le aɖuɖɔ me ɖaa le ŋkekea me), ALOO tsi si ʋẽna lilili ƒe dodo kpata si kplɔe ɖo be woatɔ keŋkeŋ.
• Ƒutsotsoe siwo nye ƒodo ƒe vevesese sesẽ, ƒodo ƒe ʋuʋu vivivi, ʋuʋudedi, kple ʋuʋudedi.
• Stoma ƒe dzedzeme trɔna: Stoma si le lãmesẽ me si ƒe amadede nye pink, si me tsi le la vuvuna kabakaba (etsona ɖe plastic wafer flange si le ostomy kotokua me) alo trɔna aɖabɛ dzĩ, aŋutiɖiɖi viviti, burgundy viviti, alo yibɔ (si fia stoma ischemia alo strangulated parastomal hernia).
• Kpekpeɖeŋu Gbãtɔ Enumake na Stoma si Vu alo Xoxe:
• Ne stoma la le ɣie, aɖabɛ, viviti, alo yibɔ, alo ne ƒu sesẽ aɖe si le veve sem le stoma la xa: Ƒo ka na 911 / 112 / 999 alo yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake.
• Ðe ostomy wafer flange si sesẽ la ɖa eye nàɖɔlii enumake: Esi stoma si xe mɔ na la le vuvum abe balloon ene la, ostomy kotoku si li fifia ƒe plastic-kplu sesẽ si wotso do ŋgɔ la wɔa dɔ abe tourniquet ene eye eƒoa stoma la tso gota. Ðe kotoku me mɔ̃a ɖa eye nàtso wafer yeye aɖe ƒe ʋuʋu milimeta 3 va ɖo 5 (inch ⅛ va ɖo ¼) wòkeke wu ƒo xlã stoma si vuvu la alo nàtsyɔ edzi wòabɔbɔ vaseɖe esime wòaɖo kɔdzi.
• Mègano aɖuɖɔtoemetike gbeɖe o eye mègade asibidɛ alo mɔ̃ sesẽwo stoma me gbeɖe le aƒeme o; le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ la, amekolawo tsɔa Foley-ka falɛfalɛ si me wode amie la yia stoma la me blewuu be wòade tsi nuɖuɖu siwo xe mɔ na wo dedie.

2. Dɔnɔ siwo wowɔ dɔ na do ŋgɔ le dɔgboa me (Roux-en-Y Internal Hernia) .¶

Amesiame si wowɔ dɔ na Roux-en-Y gastric bypass (hena lolo dzi ɖeɖe kpɔtɔ alo eƒe gbugbɔgadzɔ), ƒe 5, 10, alo 20 enye sia gɔ̃ hã la, le afɔku me le eƒe agbemeŋkekewo katã me be wòaxɔ Internal Mesenteric Hernia (Petersen defect alo jejunojejunostomy mesenteric defect):

• Nusita gastric bypass internal hernias nye alakpanuwɔwɔ alea gbegbe:
• Ne dɔgbo sue aɖe ƒe ka aɖe ge to amekoko ƒe fesre si le ememe le ƒodoa me eye wòtrɔ la, ewɔa blosed-loop strangulating obstruction na biliopancreatic limb alo Roux limb.
• Esi wònye be dɔnɔa ƒe dɔgbo ƒe kotoku sue la ma tso woƒe dɔgbo kple dɔgbo ƒe akpa mamlɛa gbɔ ta la, zi geɖe la, dɔnɔ si ƒe ƒodo ƒe titina alo akɔtave sesẽ si me DRY HEAVES (retching without being able to vomit)** kple zero ƒodo ƒe ʋuʋu le gota.
• Ƒodo ƒe X-ray siwo wowɔna ɖaa la sɔ keŋkeŋ, eye CT scan siwo wowɔna ɖaa gɔ̃ hã ate ŋu ato "mesenteric swirl dzesi" si menya kpɔna dzea sii bɔbɔe o la ŋu negbe ɖe amekola si wɔa dɔ le ʋu ƒe sisi me xlẽe hafi. Ele be dɔnɔ ɖesiaɖe si xɔa dɔgbo ƒe ʋuʋu kpata, si ƒe ƒodo ƒe akpa si le etame/titina le veve sem atraɖii la nayi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake eye agblɔ na ɖɔkta si kpɔa dɔgboa me tẽe be: "Roux-en-Y gastric bypass anatomy le asinye; taflatse da nye lãme kpɔ be ememe ʋuʋudedi aɖe le ŋunye hã."

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Nya siwo wobiaa amewo enuenu¶

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Wolé ŋku ɖe dzɔtsoƒewo ŋu¶

• Xexeame ƒe Amekoko Kpata Habɔbɔ (WSES): Bologna Mɔfiamewo ku Ðe Dɔgbo Sue ƒe Mɔxexe si Wotsɔna Kpata (ASBO) ƒe Dɔlélewo Didi Kple Wo Dzi Kpɔkpɔ Ŋu, WSES Mɔfiamewo na Ƒodo ƒe Gli ƒe Ʋuʋudedi Sesẽwo Dzadzraɖo Kpata, kple WSES Mɔfiamewo le Acute Mesenteric Ischemia Ŋu.
• Amerikatɔwo ƒe Habɔbɔ si Kpɔa Dɔgbo kple Dɔgbo ƒe Amekolawo Gbɔ (ASCRS, United States): Dɔwɔƒe ƒe Mɔfiamewo na Dɔgbo ƒe Ʋuʋudedi kple Dɔgbo Gã ƒe Mɔxexe Sesẽ.
• Ɣedzeƒe Habɔbɔ si Kpɔa Nuveviwɔame ƒe Amekoko Gbɔ (EAST, United States): Nuwɔwɔ ƒe Dɔwɔnawo Dzikpɔkpɔ ƒe Mɔfiamewo na Dɔgbo Suewo ƒe Mɔxexe Ðe Dɔléle Nu ƒe Dzesidede Kple Edzikpɔkpɔ.
• Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE) kple Fiaɖuƒea ƒe Amekolawo ƒe Kɔledzi (United Kingdom): Amekoko Gã Kpata: Dɔgbo ƒe Mɔxexe Kpata kple Dɔgbo ƒe Mɔ Siwo Woxena.
• Amerika Ðeviwo ƒe Dɔlélewo Ŋuti Nusrɔ̃ƒe (AAP): Bliious Emesis, Malrotation kple Midgut Volvulus, kple Intussusception le Vidzĩwo kple Ðeviwo me ƒe dzesidede kple edzikpɔkpɔ kpata.

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Mɔfiame siwo do ƒome kplii¶

• Appendicitis sesẽ, appendicitis si gbã, kple peritonitis ƒe aflaga dzĩwo
• Ƒodo me lãkusiwo ɖeɖe kple dɔgbo ƒe abi si le ʋuʋu ɖi dzi kpɔkpɔ
• Sepsis kple septic shock ƒe dzesidede kple kpekpeɖeŋunana gbãtɔ kpata
• Kpekpeɖeŋu gbãtɔ si dzi ŋɔ kple ʋu ƒe sisi ƒe mumu ƒe nɔnɔme
• Vidzidɔ ƒe ʋuʋu, azigolo ƒe ʋuʋu, kple akɔta ƒe vevesese sesẽ
• Xexlẽdzesi siwo woxɔna kpata le dukɔwo nu