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Review of Benign Lower GIT Disorders — Surgery Seminar

Content List for 4 Members

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📋 MEMBER 1 — Inflammatory Bowel Disease (IBD)

A. Introduction & Epidemiology

• Definition and classification (IBD spectrum)
• Epidemiology: incidence, prevalence, geographic distribution
• Risk factors: genetic, environmental, microbial

B. Pathology & Pathogenesis

• Immune dysregulation and mucosal barrier defects
• Genetic susceptibility (NOD2, HLA associations)
• Crohn's Disease (CD)
  • Transmural inflammation, skip lesions
  • Any part of GIT (mouth to anus)
  • Granuloma formation (non-caseating)
  • Gross & microscopic pathology
• Ulcerative Colitis (UC)
  • Mucosal/submucosal inflammation
  • Continuous colonic involvement (rectum → proximal)
  • Pseudopolyps, crypt abscesses
  • Gross & microscopic pathology
• Differentiation: CD vs UC — comparative table

C. Clinical Features

• Symptoms: diarrhea, rectal bleeding, abdominal pain, weight loss
• Extraintestinal manifestations (joints, skin, eyes, liver — PSC, pyoderma gangrenosum, uveitis, erythema nodosum)
• Disease activity indices: CDAI (Crohn's), Mayo score (UC)
• Complications:
  • CD: fistulae, abscess, strictures, perianal disease, obstruction
  • UC: toxic megacolon, massive hemorrhage, perforation

D. Investigations

• Colonoscopy & biopsy (gold standard)
• Imaging: CT enterography, MRI (perianal CD), small bowel follow-through
• Lab markers: CRP, ESR, fecal calprotectin, ASCA, p-ANCA
• Capsule endoscopy indications

E. Medical Management

• 5-ASA compounds (mesalazine, sulfasalazine) — UC induction/maintenance
• Corticosteroids (systemic, budesonide) — induction only
• Immunomodulators: azathioprine, 6-mercaptopurine, methotrexate
• Biologics: anti-TNF (infliximab, adalimumab), anti-integrin (vedolizumab), anti-IL-12/23 (ustekinumab)
• JAK inhibitors (tofacitinib) — UC
• Treat-to-target strategy

F. Surgical Management

• Indications: failure of medical therapy, complications, malignancy
• UC Surgery: proctocolectomy with IPAA (J-pouch), Hartmann's, end ileostomy
• CD Surgery: resection (bowel-conserving), strictureplasty, perianal surgery, drainage
• Post-op surveillance and recurrence

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📋 MEMBER 2 — Diverticular Disease of the Colon

A. Introduction & Epidemiology

• Definition: true vs false (pseudo) diverticula
• Prevalence: age-related increase, Western diet association
• Anatomical distribution: sigmoid colon predominance

B. Pathogenesis & Pathology

• Colonic wall weakness (pulsion diverticula)
• Role of fiber-deficient diet and elevated intraluminal pressure
• Gross anatomy: diverticula at mesenteric taenia sites (vasa recta penetration points)
• Microscopic features

C. Classification

• Asymptomatic diverticulosis
• Symptomatic uncomplicated diverticular disease (SUDD)
• Acute diverticulitis (uncomplicated vs complicated)
• Hinchey classification (I–IV) for complicated diverticulitis

D. Clinical Features

• Diverticulosis: often asymptomatic, LLQ pain, altered bowel habits
• Acute diverticulitis: fever, LLQ pain ("left-sided appendicitis"), rebound tenderness
• Complications: perforation, abscess, peritonitis, fistula (colovesical, colovaginal), obstruction, bleeding (diverticular hemorrhage)

E. Investigations

• CT abdomen/pelvis with contrast (gold standard for acute diverticulitis)
• Colonoscopy (6–8 weeks post-acute episode, to exclude malignancy)
• Plain AXR, US abdomen
• Lab: FBC, CRP, blood cultures

F. Management

• Uncomplicated diverticulitis
  • Outpatient: oral antibiotics, liquid diet, analgesia
  • Inpatient: IV antibiotics (ciprofloxacin + metronidazole or pip-tazo)
• Complicated diverticulitis
  • Hinchey I/II: CT-guided percutaneous drainage ± antibiotics
  • Hinchey III/IV: emergency surgery — Hartmann's procedure vs primary anastomosis
• Elective surgery indications: recurrent attacks, complications, young patients, immunosuppressed
  • Laparoscopic sigmoid colectomy (procedure of choice)
• Diverticular hemorrhage: spontaneous cessation in most; colonoscopic intervention, angioembolization, surgery for refractory cases
• Follow-up and prevention (dietary fiber, lifestyle)

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📋 MEMBER 3 — Ischemic Colitis

A. Introduction & Epidemiology

• Definition: colon ischemia due to reduced blood flow
• Most common form of GI ischemia
• Epidemiology: elderly, cardiovascular risk factors

B. Etiology & Pathogenesis

• Arterial: atherosclerosis, embolism, low-flow states (shock, cardiac failure)
• Venous: mesenteric venous thrombosis
• Watershed areas: splenic flexure (Griffiths' point), rectosigmoid junction (Sudeck's point)
• Non-occlusive ischemia (NOMI): vasospasm, medications (NSAIDs, digoxin, oral contraceptives, vasopressors)
• Iatrogenic: post-aortic surgery
• Predisposing conditions (diabetes, hypertension, atrial fibrillation, hypercoagulable states)
• Spectrum: transient reversible ischemia → gangrenous colitis

C. Clinical Features

• Classic triad: sudden crampy LLQ abdominal pain, urgent desire to defecate, passage of bright red blood per rectum
• Nausea, vomiting, low-grade fever
• Physical exam: LLQ tenderness (mild-to-moderate)
• Severe: peritoneal signs → gangrenous colitis (surgical emergency)

D. Investigations

• CT abdomen/pelvis (with contrast): bowel wall thickening, thumbprinting, pericolonic stranding
• Plain AXR: thumbprinting sign (submucosal edema/hemorrhage)
• Colonoscopy (within 48 h if not gangrenous): mucosal pallor, petechiae, ulceration — segmental distribution, rectal sparing typical
• Lab: elevated WBC, lactate (ominous), metabolic acidosis
• CTA/MRA mesenteric vessels (rule out acute mesenteric ischemia)

E. Management

• Conservative (mild-moderate)
  • IV fluids, bowel rest, IV antibiotics (broad-spectrum)
  • Optimize cardiac output, discontinue causative medications
  • Serial abdominal exams, repeat colonoscopy
• Surgical indications
  • Peritonitis, perforation, full-thickness necrosis, clinical deterioration
  • Gangrenous colitis → resection (segmental colectomy ± temporary stoma)
  • Chronic stricture → elective resection
• Post-op surveillance for stricture formation (~10%)
• Recurrence prevention: manage underlying cardiovascular risk factors

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📋 MEMBER 4 — Volvulus of the Colon

A. Introduction & Epidemiology

• Definition: axial rotation of bowel segment on its mesentery → closed-loop obstruction
• Types: sigmoid volvulus (most common, ~80%), cecal volvulus (~15–20%), transverse/splenic flexure (rare)
• Epidemiology:
  • Sigmoid: elderly, institutionalized, chronic constipation, high-fiber diet populations (Africa, Asia, Middle East)
  • Cecal: younger adults, post-surgical adhesions, pregnancy

B. Pathogenesis & Anatomy

• Sigmoid: redundant sigmoid loop on a narrow mesenteric attachment
• Cecal: mobile cecum (failure of retroperitoneal fixation)
• Degree of rotation: 180°–360°+ → vascular compromise, gangrene, perforation if untreated

C. Clinical Features

• Sigmoid volvulus: gradual onset, massive abdominal distension, constipation/obstipation, colicky pain, nausea/vomiting
• Cecal volvulus: more acute, severe pain, vomiting, lower abdominal distension
• Signs of strangulation: fever, peritonism, tachycardia → surgical emergency

D. Investigations

• Plain AXR (key diagnostic tool)
  • Sigmoid: "coffee bean" sign (inverted U-shape pointing to RUQ)
  • Cecal: kidney/comma-bean shape in LUQ or midabdomen
• CT abdomen/pelvis (with contrast): whirl sign (mesenteric twisting), beak sign, transition point — confirms diagnosis, assesses viability
• Water-soluble contrast enema: "bird's beak" / "ace of spades" — rarely needed if CT available
• Lab: FBC, metabolic panel, lactate (strangulation markers)

E. Management

• Sigmoid Volvulus — Non-gangrenous
  • First-line: endoscopic detorsion (flexible sigmoidoscopy or rigid proctoscopy)
  • Success rate ~70–90%; pass rectal tube and leave in situ 24–48 h
  • High recurrence rate (~90%) → elective sigmoid colectomy (after bowel prep) same admission
• Sigmoid Volvulus — Gangrenous / Perforated
  • Emergency laparotomy: resection + Hartmann's procedure (or primary anastomosis in selected fit patients with on-table lavage)
• Cecal Volvulus
  • Colonoscopic detorsion rarely successful
  • Surgical: right hemicolectomy (procedure of choice) or cecopexy (rarely, high recurrence)
  • Emergency: right hemicolectomy ± ileostomy if compromised bowel
• Post-operative care: NG decompression, VTE prophylaxis, stomal care if stoma formed, nutritional support

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🗂 Suggested Format for Presentation

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📚 Key References

• Sabiston Textbook of Surgery (20th/21st ed.) — Lower GI Surgery
• Schwartz's Principles of Surgery (11th ed.)
• Current Surgical Therapy (14th ed.)
• Yamada's Textbook of Gastroenterology (7th ed.)
• Robbins & Kumar Basic Pathology — GI Pathology Chapter

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Each presentation should cover: Definition → Epidemiology → Pathology/Etiology → Clinical Features → Investigations → Medical/Surgical Management → Complications → Follow-up.

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Other Benign Lower GIT Disorders

1. 🩸 Anorectal Disorders

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2. 🦠 Infectious / Inflammatory Conditions

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3. 🧱 Structural / Mechanical Disorders

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4. 🌱 Neoplastic-Benign Conditions

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5. 🔄 Functional Disorders

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6. 🩺 Miscellaneous Benign Conditions

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Summary Overview

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1. Anorectal disorders (hemorrhoids, fistula, abscess, prolapse)
2. Colorectal polyps & polyposis syndromes
3. Appendicitis
4. Ogilvie's syndrome
5. Pseudomembranous colitis (C. difficile)

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Review of Benign Lower GIT Disorders — Surgery Seminar

4 Members | 4 Topics

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📋 MEMBER 1 — Inflammatory Bowel Disease (IBD)

A. Introduction & Epidemiology

• Definition and classification (IBD spectrum)
• Epidemiology: incidence, prevalence, geographic distribution
• Risk factors: genetic, environmental, microbial

B. Pathology & Pathogenesis

• Immune dysregulation and mucosal barrier defects
• Genetic susceptibility (NOD2, HLA associations)
• Crohn's Disease (CD)
  • Transmural inflammation, skip lesions, any part of GIT
  • Non-caseating granulomas, cobblestone mucosa
  • Gross & microscopic pathology
• Ulcerative Colitis (UC)
  • Mucosal/submucosal inflammation, continuous from rectum
  • Pseudopolyps, crypt abscesses
  • Gross & microscopic pathology
• CD vs UC — Comparative Table

C. Clinical Features

• Diarrhea, rectal bleeding, abdominal pain, weight loss, fever
• Extraintestinal manifestations:
  • Joints: arthritis, ankylosing spondylitis
  • Skin: pyoderma gangrenosum, erythema nodosum
  • Eyes: uveitis, episcleritis
  • Liver: primary sclerosing cholangitis (PSC — UC)
• Disease activity scoring: CDAI (Crohn's), Mayo Score (UC)
• Complications:
  • CD: fistulae, abscess, strictures, perianal disease, small bowel obstruction
  • UC: toxic megacolon, massive hemorrhage, perforation, colorectal cancer risk

D. Investigations

• Colonoscopy + biopsy (gold standard)
• Imaging: CT enterography, MRI pelvis (perianal CD), small bowel follow-through
• Serology: ASCA (CD), p-ANCA (UC), CRP, ESR
• Fecal calprotectin (disease activity marker)
• Capsule endoscopy (small bowel CD)

E. Medical Management

• Induction:
  • 5-ASA (mesalazine/sulfasalazine) — UC
  • Corticosteroids (prednisolone, budesonide)
  • Biologics: anti-TNF (infliximab, adalimumab), anti-integrin (vedolizumab), anti-IL-12/23 (ustekinumab)
• Maintenance:
  • Azathioprine, 6-mercaptopurine, methotrexate
  • JAK inhibitors (tofacitinib) — UC
• Treat-to-target strategy (mucosal healing)

F. Surgical Management

• Indications: failed medical therapy, complications, dysplasia/malignancy
• UC: proctocolectomy + IPAA (J-pouch); Hartmann's; end ileostomy
• CD: bowel-conserving resection, strictureplasty, perianal surgery, drainage of abscess
• Post-op surveillance; recurrence management in CD

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📋 MEMBER 2 — Diverticular Disease of the Colon

A. Introduction & Epidemiology

• Definition: true vs false (pseudo) diverticula
• Prevalence increases with age; predominant in Western populations
• Sigmoid colon most commonly affected (~95%)

B. Pathogenesis & Pathology

• Low-fiber diet → elevated intraluminal pressure → mucosal herniation
• Pulsion diverticula at sites where vasa recta penetrate the muscularis propria
• Gross anatomy and microscopic features

C. Classification

• Asymptomatic diverticulosis
• Symptomatic uncomplicated diverticular disease (SUDD)
• Acute uncomplicated diverticulitis
• Acute complicated diverticulitis
• Hinchey Classification (I–IV):
  • I: Pericolic abscess
  • II: Pelvic/distant abscess
  • III: Purulent peritonitis
  • IV: Fecal peritonitis

D. Clinical Features

• Diverticulosis: often asymptomatic; LLQ pain, bloating, altered bowel habits
• Acute diverticulitis: fever, LLQ pain ("left-sided appendicitis"), nausea, leukocytosis
• Complications: perforation, abscess, peritonitis, fistula (colovesical — pneumaturia, fecaluria; colovaginal), obstruction
• Diverticular hemorrhage: painless massive rectal bleeding; often right-sided; spontaneous cessation in 75–80%

E. Investigations

• CT abdomen/pelvis with IV contrast (gold standard for acute diverticulitis)
• Colonoscopy (6–8 weeks post-acute episode to exclude malignancy)
• Plain AXR, abdominal USS
• Lab: FBC, CRP, U&E, blood cultures

F. Management

• Uncomplicated diverticulitis:
  • Mild: oral antibiotics (ciprofloxacin + metronidazole), liquid diet, outpatient
  • Moderate-severe: IV antibiotics (piperacillin-tazobactam), inpatient, bowel rest
• Complicated diverticulitis:
  • Hinchey I/II: CT-guided percutaneous drainage + IV antibiotics
  • Hinchey III/IV: emergency surgery → Hartmann's procedure (resection + end colostomy) or primary anastomosis ± defunctioning stoma
• Elective surgery indications: recurrent episodes, complications, young/immunosuppressed
  • Laparoscopic sigmoid colectomy (gold standard)
• Diverticular hemorrhage: colonoscopic hemostasis, CT angiography + embolization, surgery if refractory
• Prevention: high-fiber diet, avoid NSAIDs

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📋 MEMBER 3 — Ischemic Colitis

A. Introduction & Epidemiology

• Definition: inadequate blood supply to the colon → ischemic injury
• Most common form of GI ischemia
• Primarily affects elderly patients with cardiovascular comorbidities

B. Etiology & Pathogenesis

• Occlusive: atherosclerosis, embolism (AF, cardiac), mesenteric venous thrombosis
• Non-occlusive (NOMI): low-flow states (shock, cardiac failure, vasopressors), drugs (NSAIDs, digoxin, OCP, cocaine)
• Iatrogenic: post-aortic aneurysm repair (IMA ligation)
• Watershed areas at greatest risk:
  • Splenic flexure (Griffiths' point) — SMA/IMA junction
  • Rectosigmoid junction (Sudeck's point) — IMA/pudendal junction
• Spectrum: transient reversible ischemia → chronic stricture → gangrenous colitis

C. Clinical Features

• Classic triad: sudden crampy LLQ pain + urgent defecation + passage of bright red blood PR
• Nausea, vomiting, low-grade fever
• Mild-moderate: LLQ tenderness without peritonism
• Gangrenous colitis (severe): peritonitis, fever, tachycardia, hemodynamic instability → surgical emergency
• Rectal bleeding + abdominal pain in elderly with vascular disease = ischemic colitis until proven otherwise

D. Investigations

• CT abdomen/pelvis (contrast): bowel wall thickening, pericolonic fat stranding, pneumatosis (ominous), portal venous gas
• Plain AXR: thumbprinting sign (submucosal edema/hemorrhage)
• Colonoscopy (within 48 h if no peritonism): segmental mucosal pallor, petechiae, hemorrhagic ulceration — rectal sparing typical
• Lab: raised WBC, CRP; elevated lactate + metabolic acidosis = strangulation/gangrene
• CT angiography to exclude acute mesenteric ischemia (SMA/IMA)

E. Management

• Conservative (mild-moderate):
  • IV fluids, bowel rest, broad-spectrum IV antibiotics
  • Optimize cardiac output and blood pressure
  • Discontinue causative medications
  • Serial clinical reassessment + repeat colonoscopy
• Surgical indications:
  • Peritonitis, perforation, full-thickness necrosis, clinical deterioration despite treatment
  • Gangrenous colitis → emergency laparotomy + segmental/subtotal colectomy ± Hartmann's
  • Chronic stricture → elective resection
• Post-op: stoma care, nutritional support, VTE prophylaxis
• Long-term: stricture surveillance (~10%), manage cardiovascular risk factors

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📋 MEMBER 4 — Volvulus of the Colon

A. Introduction & Epidemiology

• Definition: axial torsion of a bowel segment on its mesentery → closed-loop obstruction + vascular compromise
• Types by frequency:
  • Sigmoid volvulus (~80%)
  • Cecal volvulus (~15–20%)
  • Transverse colon / splenic flexure volvulus (rare)
• Sigmoid: elderly, institutionalized, chronic constipation, high-fiber diet populations (Africa, Middle East, Asia — "volvulus belt")
• Cecal: younger adults, post-surgical adhesions, pregnancy, malrotation

B. Pathogenesis & Anatomy

• Sigmoid: redundant loop + narrow mesenteric attachment → prone to twisting
• Cecal: mobile cecum (failed retroperitoneal fixation) → axial or "bascule" flip
• Rotation ≥180° → venous obstruction → edema → arterial compromise → gangrene → perforation

C. Clinical Features

• Sigmoid volvulus:
  • Gradual onset, massive abdominal distension (hallmark), obstipation, colicky pain, nausea/vomiting
  • Asymmetric distension, tympanitic abdomen
• Cecal volvulus:
  • More acute onset, severe colicky pain, vomiting
  • Distension less pronounced, often RUQ/central
• Signs of strangulation (both): fever, peritonism, tachycardia, hemodynamic compromise → emergency laparotomy

D. Investigations

• Plain AXR (key first investigation):
  • Sigmoid: "coffee bean" / "omega loop" sign — inverted U pointing to RUQ; absent rectal gas
  • Cecal: kidney/comma shape displaced to LUQ or midabdomen
• CT abdomen/pelvis with contrast (confirmatory):
  • "Whirl sign" (mesenteric twisting)
  • "Beak sign" at site of torsion
  • Transition point, bowel wall enhancement loss (ischemia)
• Water-soluble contrast enema: "bird's beak" / "ace of spades" deformity — rarely needed if CT available
• Lab: FBC, metabolic panel, serum lactate (elevated = strangulation)

E. Management

Sigmoid Volvulus — Non-gangrenous

• First-line: endoscopic detorsion (flexible sigmoidoscopy or rigid proctoscopy)
  • Success rate 70–90%
  • Pass rectal tube + leave in situ 24–48 h for decompression
  • High recurrence (~90%) → elective sigmoid colectomy same admission (after bowel prep)

Sigmoid Volvulus — Gangrenous / Perforated

• Emergency laparotomy
• Hartmann's procedure (resection + end colostomy) — standard
• Primary anastomosis ± defunctioning ileostomy in selected fit patients

Cecal Volvulus

• Colonoscopic detorsion rarely successful
• Surgical (treatment of choice):
  • Right hemicolectomy — definitive; removes mobile cecum
  • Cecopexy alone — high recurrence (not preferred)
  • Emergency: right hemicolectomy ± ileostomy if compromised bowel

F. Post-operative Care (All Volvulus)

• NG tube decompression
• IV fluids + electrolyte correction
• VTE prophylaxis
• Stoma care and education (if stoma formed)
• Nutritional support
• Elective stoma reversal planning (Hartmann's reversal at 3–6 months)

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🗂 Summary Table

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📚 Key References

• Sabiston Textbook of Surgery
• Schwartz's Principles of Surgery (11th ed.)
• Current Surgical Therapy (14th ed.)
• Yamada's Textbook of Gastroenterology (7th ed.)
• Robbins & Kumar Basic Pathology

Benign Lower GIT Disorders — Content List for 4 Members

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MEMBER 1 — Inflammatory Bowel Disease (IBD)

1. Definition & Classification
2. Epidemiology & Risk Factors
3. Pathogenesis
4. Pathology — Crohn's Disease
5. Pathology — Ulcerative Colitis
6. CD vs UC Comparison Table
7. Clinical Features
8. Extraintestinal Manifestations
9. Disease Activity Scoring (CDAI / Mayo Score)
10. Complications — CD
11. Complications — UC
12. Investigations
13. Medical Management — Induction
14. Medical Management — Maintenance
15. Surgical Management — Indications
16. Surgery for UC
17. Surgery for CD
18. Post-operative Surveillance

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MEMBER 2 — Diverticular Disease of the Colon

1. Definition — True vs False Diverticula
2. Epidemiology
3. Pathogenesis & Anatomy
4. Classification (Asymptomatic / SUDD / Uncomplicated / Complicated)
5. Hinchey Classification (I–IV)
6. Clinical Features — Diverticulosis
7. Clinical Features — Acute Diverticulitis
8. Complications (Abscess, Fistula, Obstruction, Perforation)
9. Diverticular Hemorrhage
10. Investigations
11. Management — Uncomplicated Diverticulitis
12. Management — Complicated Diverticulitis
13. Emergency Surgery (Hartmann's vs Primary Anastomosis)
14. Elective Surgery — Indications & Procedure
15. Management of Diverticular Hemorrhage
16. Prevention & Follow-up

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MEMBER 3 — Ischemic Colitis

1. Definition & Epidemiology
2. Etiology — Occlusive Causes
3. Etiology — Non-occlusive Causes (NOMI)
4. Iatrogenic Causes
5. Watershed Areas (Griffiths' Point / Sudeck's Point)
6. Spectrum of Disease
7. Clinical Features — Mild/Moderate
8. Clinical Features — Gangrenous (Severe)
9. Investigations
10. Radiological Findings (CT / AXR Signs)
11. Colonoscopic Findings
12. Conservative Management
13. Surgical Indications
14. Surgical Management
15. Post-operative Care
16. Long-term Follow-up & Prevention

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MEMBER 4 — Volvulus of the Colon

1. Definition
2. Types & Frequency (Sigmoid / Cecal / Others)
3. Epidemiology — Sigmoid Volvulus
4. Epidemiology — Cecal Volvulus
5. Pathogenesis & Anatomy — Sigmoid
6. Pathogenesis & Anatomy — Cecal
7. Clinical Features — Sigmoid Volvulus
8. Clinical Features — Cecal Volvulus
9. Signs of Strangulation
10. Plain AXR Findings (Coffee Bean Sign / Kidney Shape)
11. CT Findings (Whirl Sign / Beak Sign)
12. Other Investigations
13. Management — Sigmoid (Non-gangrenous): Endoscopic Detorsion
14. Management — Sigmoid (Gangrenous): Emergency Surgery
15. Management — Cecal Volvulus: Right Hemicolectomy
16. Elective Surgery After Detorsion
17. Post-operative Care

Benign Lower GIT Disorders — Content List (MBBS Level)

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MEMBER 1 — Inflammatory Bowel Disease (IBD)

1. Definition & Types (Crohn's vs UC)
2. Epidemiology & Risk Factors
3. Pathology — Crohn's Disease
4. Pathology — Ulcerative Colitis
5. CD vs UC Comparison Table
6. Clinical Features
7. Extraintestinal Manifestations
8. Complications
9. Investigations
10. Medical Treatment
11. Surgical Treatment
12. Prognosis

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MEMBER 2 — Diverticular Disease of the Colon

1. Definition
2. Epidemiology & Risk Factors
3. Pathogenesis
4. Clinical Features — Diverticulosis
5. Clinical Features — Acute Diverticulitis
6. Complications
7. Investigations
8. Medical Management
9. Surgical Management
10. Prognosis & Prevention

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MEMBER 3 — Ischemic Colitis

1. Definition & Epidemiology
2. Causes & Risk Factors
3. Watershed Areas of the Colon
4. Clinical Features
5. Investigations
6. Medical Management
7. Surgical Management
8. Prognosis

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MEMBER 4 — Volvulus of the Colon

1. Definition & Types
2. Epidemiology & Risk Factors
3. Pathogenesis
4. Clinical Features — Sigmoid Volvulus
5. Clinical Features — Cecal Volvulus
6. Investigations & X-ray Signs
7. Management — Sigmoid Volvulus
8. Management — Cecal Volvulus
9. Complications & Prognosis