Overview
Strangulation of the colon refers to the compression or obstruction of the colon by external forces, often seen in cases of physical abuse or torture, leading to potential ischemia and necrosis if severe 2.Diagnosis
Clinical Presentation: Abdominal pain, distension, hematochezia, and signs of peritonitis in severe cases 2.
Physical Examination: Palpable abdominal masses, guarding, and rebound tenderness 2.
Imaging: CT abdomen with contrast to identify bowel wall thickening, pneumatosis intestinalis, or portal venous gas 2.
Endoscopy: Colonoscopy may reveal ischemic changes or mucosal necrosis 2.
Differential Diagnosis: Includes mechanical bowel obstruction, inflammatory bowel disease, and other forms of trauma 2.Management
Surgical Intervention: Resection of necrotic segments and primary anastomosis if feasible; diversion procedures (ileostomy) may be necessary in severe cases 2.
Supportive Care: Fluid resuscitation, broad-spectrum antibiotics to prevent infection, and monitoring for sepsis 2.
Psychological Support: Essential for survivors of torture, integrating mental health services alongside physical care 4.Special Populations
Torture Survivors: Require comprehensive care addressing both physical and psychological trauma 45.
No Specific Guidance: Limited evidence provided for pregnancy, pediatrics, or elderly populations 1245.Key Recommendations
Imaging and Endoscopy for Diagnosis: Utilize CT imaging and colonoscopy to accurately diagnose strangulation of the colon (Evidence: Moderate 2).
Surgical Intervention Based on Severity: Perform surgical resection for necrotic segments and consider diversion procedures in severe cases (Evidence: Moderate 2).
Integrated Psychological Support: Provide concurrent psychological support for survivors of torture to address trauma (Evidence: Expert opinion 4).References
1 Jelousi S, Montejano D, Jaradeh K, Kivlahan C, Shinkai K, Chang AY. Evaluation of a pilot forensic dermatology curriculum in the USA. Clinical and experimental dermatology 2022. link
2 Deps PD, Aborghetti HP, Zambon TL, Costa VC, Dos Santos JD, Collin SM et al.. Assessing signs of torture: A review of clinical forensic dermatology. Journal of the American Academy of Dermatology 2022. link
3 Kennedy P. Working with survivors of torture in Sarajevo with Reiki. Complementary therapies in nursing & midwifery 2001. link
4 Laurence R. Part II: The treatment of torture survivors: a review of the literature. Issues in mental health nursing 1992. link
5 Turner S, Van Velsen C. Victims of torture. British journal of hospital medicine 1990. link