SlideShare a Scribd company logo
1 of 48
Ischemic Colitis By Maha K. AL-Madi General Surgery – KFHU Khobar – Saudi Arabia April 8, 2009
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy Review ,[object Object]
6 cm 15 cm 13cm 25-38cm 25cm 12 cm 3cm
Anatomy Review ,[object Object]
Anatomy Review ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Anatomy Review ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Anatomy Review ,[object Object],[object Object],[object Object]
Anatomy Review ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Anatomy Review ,[object Object],[object Object],[object Object],[object Object]
Ischemic Colitis- Introduction ,[object Object],[object Object]
Ischemic Colitis- Introduction ,[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object]
Underlying Causes
 
 
 
Phases of Ischemic Colitis ,[object Object],[object Object]
Phases of Ischemic Colitis ,[object Object],Mucosal infarction in which ischemic damage is confined to the mucosa 2.  Partial thickness ischemia Mural infarction in which the injury extends from the mucosa into the muscularis mucosa 3.  Full thickness infarction Transmural infarction
Phases of Ischemic Colitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Picture ,[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Investigations ,[object Object],[object Object],[object Object],[object Object]
 
 
Investigations ,[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object]
 
 
Management ,[object Object]
Management ,[object Object],Treated symptomatically Observation with  Bowel rest, IVF, O2 and optomise cardiac function 2.  Partial thickness ischemia -Close observation, IVF, broad-spectrum antibiotics -If stricture develops and is symptomatic, resection may be required. 3.  Full thickness infarction Surgical resection
Management ,[object Object],[object Object],[object Object]
 
Management ,[object Object],[object Object]
Management ,[object Object],[object Object],[object Object]
Management ,[object Object]
Reference  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank You

More Related Content

What's hot

Lower Gastrointestinal Bleeding
Lower Gastrointestinal BleedingLower Gastrointestinal Bleeding
Lower Gastrointestinal BleedingAfiqah Faizal
 
Crohns disease
Crohns diseaseCrohns disease
Crohns diseasesyed ubaid
 
Acute and Chronic Cholecystitis
Acute and Chronic CholecystitisAcute and Chronic Cholecystitis
Acute and Chronic CholecystitisSujith Jose
 
Sigmoid volvulus/ Generalised abdominal pain
Sigmoid volvulus/  Generalised abdominal painSigmoid volvulus/  Generalised abdominal pain
Sigmoid volvulus/ Generalised abdominal painSelvaraj Balasubramani
 
ACUTE MESENTERIC ISCHAEMIA
ACUTE MESENTERIC ISCHAEMIAACUTE MESENTERIC ISCHAEMIA
ACUTE MESENTERIC ISCHAEMIAArkaprovo Roy
 
Pyogenic liver abscess
Pyogenic liver abscessPyogenic liver abscess
Pyogenic liver abscessPratap Tiwari
 
Lower GastroIntestinal Bleeding
Lower GastroIntestinal  BleedingLower GastroIntestinal  Bleeding
Lower GastroIntestinal BleedingDr Mubashir Bashir
 
Obstructive jaundice
Obstructive jaundiceObstructive jaundice
Obstructive jaundiceSilah Aysha
 
Acute cholecystitis..
Acute cholecystitis..Acute cholecystitis..
Acute cholecystitis..Sarif Raza
 
Surgical complications of Gastrectomy
Surgical complications of GastrectomySurgical complications of Gastrectomy
Surgical complications of GastrectomyBala Sankar
 
Acute Calculous Cholecystitis
Acute Calculous CholecystitisAcute Calculous Cholecystitis
Acute Calculous CholecystitisSun Yai-Cheng
 

What's hot (20)

Lower Gastrointestinal Bleeding
Lower Gastrointestinal BleedingLower Gastrointestinal Bleeding
Lower Gastrointestinal Bleeding
 
Crohns disease
Crohns diseaseCrohns disease
Crohns disease
 
Acute and Chronic Cholecystitis
Acute and Chronic CholecystitisAcute and Chronic Cholecystitis
Acute and Chronic Cholecystitis
 
Acute cholecystitis/ RUQ Pain
Acute cholecystitis/ RUQ PainAcute cholecystitis/ RUQ Pain
Acute cholecystitis/ RUQ Pain
 
Ischemic bowel disease
Ischemic bowel diseaseIschemic bowel disease
Ischemic bowel disease
 
Sigmoid volvulus/ Generalised abdominal pain
Sigmoid volvulus/  Generalised abdominal painSigmoid volvulus/  Generalised abdominal pain
Sigmoid volvulus/ Generalised abdominal pain
 
ACUTE MESENTERIC ISCHAEMIA
ACUTE MESENTERIC ISCHAEMIAACUTE MESENTERIC ISCHAEMIA
ACUTE MESENTERIC ISCHAEMIA
 
Pyogenic liver abscess
Pyogenic liver abscessPyogenic liver abscess
Pyogenic liver abscess
 
Lower GastroIntestinal Bleeding
Lower GastroIntestinal  BleedingLower GastroIntestinal  Bleeding
Lower GastroIntestinal Bleeding
 
Lower GI - Bleed
Lower GI - Bleed Lower GI - Bleed
Lower GI - Bleed
 
Mallory weiss syndrome
Mallory weiss syndromeMallory weiss syndrome
Mallory weiss syndrome
 
Splenic trauma
Splenic traumaSplenic trauma
Splenic trauma
 
Obstructive jaundice
Obstructive jaundiceObstructive jaundice
Obstructive jaundice
 
Acute cholecystitis..
Acute cholecystitis..Acute cholecystitis..
Acute cholecystitis..
 
Volvulus of colon
Volvulus of colonVolvulus of colon
Volvulus of colon
 
Surgical complications of Gastrectomy
Surgical complications of GastrectomySurgical complications of Gastrectomy
Surgical complications of Gastrectomy
 
Acute Calculous Cholecystitis
Acute Calculous CholecystitisAcute Calculous Cholecystitis
Acute Calculous Cholecystitis
 
Esophageal varices
Esophageal varicesEsophageal varices
Esophageal varices
 
Gastric cancer
Gastric cancerGastric cancer
Gastric cancer
 
Small Intestine TB (Tuberculosis)
Small Intestine TB (Tuberculosis)Small Intestine TB (Tuberculosis)
Small Intestine TB (Tuberculosis)
 

Viewers also liked

Mesenteric ischemia
Mesenteric ischemiaMesenteric ischemia
Mesenteric ischemiakrisshk1989
 
Acute Mesenteric Ischaemia: An Abdominal Calamity
Acute Mesenteric Ischaemia: An Abdominal CalamityAcute Mesenteric Ischaemia: An Abdominal Calamity
Acute Mesenteric Ischaemia: An Abdominal CalamityKETAN VAGHOLKAR
 
Inflammatory bowel disease
Inflammatory bowel diseaseInflammatory bowel disease
Inflammatory bowel diseaseParichi Buch
 
Human digestive system
Human digestive systemHuman digestive system
Human digestive systemAroma noori
 
Acute epiploeic appendagitis.pptx2
Acute epiploeic appendagitis.pptx2Acute epiploeic appendagitis.pptx2
Acute epiploeic appendagitis.pptx2Ritesh Mahajan
 
Mesenteric ischemia presentation by Dr.NOSHI Capital Hospital Islamabad Paki...
Mesenteric ischemia  presentation by Dr.NOSHI Capital Hospital Islamabad Paki...Mesenteric ischemia  presentation by Dr.NOSHI Capital Hospital Islamabad Paki...
Mesenteric ischemia presentation by Dr.NOSHI Capital Hospital Islamabad Paki...drfarhanali2008
 
GEMC: Mesenteric Ischemia: Resident Training
GEMC: Mesenteric Ischemia: Resident Training GEMC: Mesenteric Ischemia: Resident Training
GEMC: Mesenteric Ischemia: Resident Training Open.Michigan
 
Skeletal muscle pathology MADE EASY by fahad
Skeletal muscle pathology MADE EASY by fahadSkeletal muscle pathology MADE EASY by fahad
Skeletal muscle pathology MADE EASY by fahadLWCH, UAE
 
inflammatory Bowel disease
inflammatory Bowel diseaseinflammatory Bowel disease
inflammatory Bowel diseaseLWCH, UAE
 
Management of varicose veins RRT
Management of varicose veins RRTManagement of varicose veins RRT
Management of varicose veins RRTRanjith Thampi
 
Git Cholestatic Liver Dis2010
Git Cholestatic Liver Dis2010Git Cholestatic Liver Dis2010
Git Cholestatic Liver Dis2010Shaikhani.
 
CT Imaging of Bowel Wall Thickening
CT Imaging  of Bowel Wall Thickening CT Imaging  of Bowel Wall Thickening
CT Imaging of Bowel Wall Thickening Sakher Alkhaderi
 
Diverticulosis and diverticulitis
Diverticulosis and diverticulitisDiverticulosis and diverticulitis
Diverticulosis and diverticulitisKimberly Treier
 
Surgical anatomy of salivary glands
Surgical anatomy of salivary glandsSurgical anatomy of salivary glands
Surgical anatomy of salivary glandsDr./ Ihab Samy
 

Viewers also liked (20)

Case study ischaemic colitis
Case study ischaemic colitisCase study ischaemic colitis
Case study ischaemic colitis
 
Mesenteric ischemia
Mesenteric ischemiaMesenteric ischemia
Mesenteric ischemia
 
Acute Mesenteric Ischaemia: An Abdominal Calamity
Acute Mesenteric Ischaemia: An Abdominal CalamityAcute Mesenteric Ischaemia: An Abdominal Calamity
Acute Mesenteric Ischaemia: An Abdominal Calamity
 
Ulcerative colitis
Ulcerative colitisUlcerative colitis
Ulcerative colitis
 
Inflammatory bowel disease
Inflammatory bowel diseaseInflammatory bowel disease
Inflammatory bowel disease
 
Human digestive system
Human digestive systemHuman digestive system
Human digestive system
 
Acute epiploeic appendagitis.pptx2
Acute epiploeic appendagitis.pptx2Acute epiploeic appendagitis.pptx2
Acute epiploeic appendagitis.pptx2
 
Mesenteric ischemia presentation by Dr.NOSHI Capital Hospital Islamabad Paki...
Mesenteric ischemia  presentation by Dr.NOSHI Capital Hospital Islamabad Paki...Mesenteric ischemia  presentation by Dr.NOSHI Capital Hospital Islamabad Paki...
Mesenteric ischemia presentation by Dr.NOSHI Capital Hospital Islamabad Paki...
 
Mesenteric ischemia
Mesenteric ischemia Mesenteric ischemia
Mesenteric ischemia
 
GEMC: Mesenteric Ischemia: Resident Training
GEMC: Mesenteric Ischemia: Resident Training GEMC: Mesenteric Ischemia: Resident Training
GEMC: Mesenteric Ischemia: Resident Training
 
Skeletal muscle pathology MADE EASY by fahad
Skeletal muscle pathology MADE EASY by fahadSkeletal muscle pathology MADE EASY by fahad
Skeletal muscle pathology MADE EASY by fahad
 
Urology
UrologyUrology
Urology
 
inflammatory Bowel disease
inflammatory Bowel diseaseinflammatory Bowel disease
inflammatory Bowel disease
 
Bowel wall thickening at ct
Bowel wall thickening at ctBowel wall thickening at ct
Bowel wall thickening at ct
 
Management of varicose veins RRT
Management of varicose veins RRTManagement of varicose veins RRT
Management of varicose veins RRT
 
Git Cholestatic Liver Dis2010
Git Cholestatic Liver Dis2010Git Cholestatic Liver Dis2010
Git Cholestatic Liver Dis2010
 
Peripheral Neuropathies (Guillian Barre & Myasthenia Gravis)
Peripheral Neuropathies (Guillian Barre & Myasthenia Gravis)Peripheral Neuropathies (Guillian Barre & Myasthenia Gravis)
Peripheral Neuropathies (Guillian Barre & Myasthenia Gravis)
 
CT Imaging of Bowel Wall Thickening
CT Imaging  of Bowel Wall Thickening CT Imaging  of Bowel Wall Thickening
CT Imaging of Bowel Wall Thickening
 
Diverticulosis and diverticulitis
Diverticulosis and diverticulitisDiverticulosis and diverticulitis
Diverticulosis and diverticulitis
 
Surgical anatomy of salivary glands
Surgical anatomy of salivary glandsSurgical anatomy of salivary glands
Surgical anatomy of salivary glands
 

Similar to Ischemic Colitis

Vascular Diseases of the Bowel
Vascular Diseases of the Bowel  Vascular Diseases of the Bowel
Vascular Diseases of the Bowel Joisy Aloor
 
acute mesentric ischemia sanaa university .ppt
acute mesentric ischemia sanaa university .pptacute mesentric ischemia sanaa university .ppt
acute mesentric ischemia sanaa university .pptssuser69abc5
 
Combined 05 clinical training--pathology benign_ischemic colitis
Combined 05 clinical training--pathology benign_ischemic colitisCombined 05 clinical training--pathology benign_ischemic colitis
Combined 05 clinical training--pathology benign_ischemic colitisIknifem
 
Bowel obstruction
Bowel obstruction Bowel obstruction
Bowel obstruction Srini Vasan
 
Intestinal ( Bowel) strangulation
Intestinal ( Bowel) strangulationIntestinal ( Bowel) strangulation
Intestinal ( Bowel) strangulationEslam Awesh
 
Imaging of small bowel pathologies
Imaging of small bowel pathologiesImaging of small bowel pathologies
Imaging of small bowel pathologiesGirendra Shankar
 
Esophagus : Benign and Malignant diseases
Esophagus : Benign and Malignant diseasesEsophagus : Benign and Malignant diseases
Esophagus : Benign and Malignant diseasesRidham Khanderia
 
Mesenteric Ischemia
Mesenteric IschemiaMesenteric Ischemia
Mesenteric IschemiaKIST Surgery
 
Intestinal obstruction in small animals
Intestinal obstruction in small animalsIntestinal obstruction in small animals
Intestinal obstruction in small animalsDr Alok Bharti
 
Abdominal Injuries: splenic rupture, liver injury
Abdominal Injuries: splenic rupture, liver injuryAbdominal Injuries: splenic rupture, liver injury
Abdominal Injuries: splenic rupture, liver injuryIgbashio
 
Small bowel lymphoma
Small bowel lymphomaSmall bowel lymphoma
Small bowel lymphomamaimusirdan
 
intestinal obstruction.pptx
intestinal obstruction.pptxintestinal obstruction.pptx
intestinal obstruction.pptxselma446644
 
carcinoma of stomach
 carcinoma of  stomach carcinoma of  stomach
carcinoma of stomachVeeru Reddy
 
presentation_THurs.docx
presentation_THurs.docxpresentation_THurs.docx
presentation_THurs.docxDakaneMaalim
 
Acute mesenteric arterial disease
Acute mesenteric arterial diseaseAcute mesenteric arterial disease
Acute mesenteric arterial diseaseTapish Sahu
 
Mesenteric Ischemia
Mesenteric Ischemia Mesenteric Ischemia
Mesenteric Ischemia KIST Surgery
 

Similar to Ischemic Colitis (20)

Vascular Diseases of the Bowel
Vascular Diseases of the Bowel  Vascular Diseases of the Bowel
Vascular Diseases of the Bowel
 
acute mesentric ischemia sanaa university .ppt
acute mesentric ischemia sanaa university .pptacute mesentric ischemia sanaa university .ppt
acute mesentric ischemia sanaa university .ppt
 
Combined 05 clinical training--pathology benign_ischemic colitis
Combined 05 clinical training--pathology benign_ischemic colitisCombined 05 clinical training--pathology benign_ischemic colitis
Combined 05 clinical training--pathology benign_ischemic colitis
 
Bowel obstruction
Bowel obstruction Bowel obstruction
Bowel obstruction
 
Intestinal ( Bowel) strangulation
Intestinal ( Bowel) strangulationIntestinal ( Bowel) strangulation
Intestinal ( Bowel) strangulation
 
Imaging of small bowel pathologies
Imaging of small bowel pathologiesImaging of small bowel pathologies
Imaging of small bowel pathologies
 
Esophagus : Benign and Malignant diseases
Esophagus : Benign and Malignant diseasesEsophagus : Benign and Malignant diseases
Esophagus : Benign and Malignant diseases
 
Esophageal disorders
Esophageal disordersEsophageal disorders
Esophageal disorders
 
Mesenteric Ischemia
Mesenteric IschemiaMesenteric Ischemia
Mesenteric Ischemia
 
Intestinal obstruction in small animals
Intestinal obstruction in small animalsIntestinal obstruction in small animals
Intestinal obstruction in small animals
 
Abdominal Injuries: splenic rupture, liver injury
Abdominal Injuries: splenic rupture, liver injuryAbdominal Injuries: splenic rupture, liver injury
Abdominal Injuries: splenic rupture, liver injury
 
Small bowel lymphoma
Small bowel lymphomaSmall bowel lymphoma
Small bowel lymphoma
 
intestinal obstruction.pptx
intestinal obstruction.pptxintestinal obstruction.pptx
intestinal obstruction.pptx
 
carcinoma of stomach
 carcinoma of  stomach carcinoma of  stomach
carcinoma of stomach
 
inflammatory bowel disease (IBD)
inflammatory bowel disease (IBD)inflammatory bowel disease (IBD)
inflammatory bowel disease (IBD)
 
presentation_THurs.docx
presentation_THurs.docxpresentation_THurs.docx
presentation_THurs.docx
 
Intestinal obstruction
Intestinal obstructionIntestinal obstruction
Intestinal obstruction
 
Rif mass
Rif massRif mass
Rif mass
 
Acute mesenteric arterial disease
Acute mesenteric arterial diseaseAcute mesenteric arterial disease
Acute mesenteric arterial disease
 
Mesenteric Ischemia
Mesenteric Ischemia Mesenteric Ischemia
Mesenteric Ischemia
 

More from Saeed Al-Shomimi

Pathophysiology of wound healing
Pathophysiology of wound healingPathophysiology of wound healing
Pathophysiology of wound healingSaeed Al-Shomimi
 
Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Saeed Al-Shomimi
 
Retroperitoneal Collections
Retroperitoneal CollectionsRetroperitoneal Collections
Retroperitoneal CollectionsSaeed Al-Shomimi
 
How to do - Abdominal Trauma
How to do - Abdominal TraumaHow to do - Abdominal Trauma
How to do - Abdominal TraumaSaeed Al-Shomimi
 
Breast Cancer during pregnancy
Breast Cancer during pregnancyBreast Cancer during pregnancy
Breast Cancer during pregnancySaeed Al-Shomimi
 
Antibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisAntibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisSaeed Al-Shomimi
 
Esophaegeal resection & reconstruction
Esophaegeal resection & reconstructionEsophaegeal resection & reconstruction
Esophaegeal resection & reconstructionSaeed Al-Shomimi
 
A v fistula in heamodialysis
A v fistula in heamodialysisA v fistula in heamodialysis
A v fistula in heamodialysisSaeed Al-Shomimi
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular TraumaSaeed Al-Shomimi
 
Risk Factors of Breast Cancer
Risk Factors of Breast CancerRisk Factors of Breast Cancer
Risk Factors of Breast CancerSaeed Al-Shomimi
 
Surgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSurgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSaeed Al-Shomimi
 
Endocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasEndocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasSaeed Al-Shomimi
 

More from Saeed Al-Shomimi (20)

Pathophysiology of wound healing
Pathophysiology of wound healingPathophysiology of wound healing
Pathophysiology of wound healing
 
Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...
 
Retroperitoneal Collections
Retroperitoneal CollectionsRetroperitoneal Collections
Retroperitoneal Collections
 
Tube thoracostomy
Tube thoracostomyTube thoracostomy
Tube thoracostomy
 
How to do - Abdominal Trauma
How to do - Abdominal TraumaHow to do - Abdominal Trauma
How to do - Abdominal Trauma
 
Breast Cancer during pregnancy
Breast Cancer during pregnancyBreast Cancer during pregnancy
Breast Cancer during pregnancy
 
Antibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisAntibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute Panceriatitis
 
Gallstone
GallstoneGallstone
Gallstone
 
Esophaegeal resection & reconstruction
Esophaegeal resection & reconstructionEsophaegeal resection & reconstruction
Esophaegeal resection & reconstruction
 
A v fistula in heamodialysis
A v fistula in heamodialysisA v fistula in heamodialysis
A v fistula in heamodialysis
 
DVT Current Concept
DVT Current ConceptDVT Current Concept
DVT Current Concept
 
Diabetic Foot Examination
Diabetic Foot ExaminationDiabetic Foot Examination
Diabetic Foot Examination
 
Solitary Thyroid Nodule
Solitary Thyroid NoduleSolitary Thyroid Nodule
Solitary Thyroid Nodule
 
Massive Blood Transfusion
Massive Blood TransfusionMassive Blood Transfusion
Massive Blood Transfusion
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular Trauma
 
Risk Factors of Breast Cancer
Risk Factors of Breast CancerRisk Factors of Breast Cancer
Risk Factors of Breast Cancer
 
Liver Trauma
Liver TraumaLiver Trauma
Liver Trauma
 
Surgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSurgical Management in Ulcerative Colitis
Surgical Management in Ulcerative Colitis
 
Endocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasEndocrine Tumors Of The Pancreas
Endocrine Tumors Of The Pancreas
 
Gastric Carcinoma
Gastric CarcinomaGastric Carcinoma
Gastric Carcinoma
 

Recently uploaded

Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service AvailableTrichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service AvailableGENUINE ESCORT AGENCY
 
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...chandars293
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...khalifaescort01
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...jageshsingh5554
 
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Kurnool Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kurnool Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Kurnool Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kurnool Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Anamika Rawat
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...narwatsonia7
 
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426jennyeacort
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Dipal Arora
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...narwatsonia7
 
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service AvailableGENUINE ESCORT AGENCY
 
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappMost Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappInaaya Sharma
 
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service AvailableDipal Arora
 
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...hotbabesbook
 
Call Girls Guntur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Guntur  Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Guntur  Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Guntur Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...narwatsonia7
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...GENUINE ESCORT AGENCY
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Ishani Gupta
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...parulsinha
 

Recently uploaded (20)

Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service AvailableTrichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
 
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Kurnool Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kurnool Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Kurnool Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kurnool Just Call 8250077686 Top Class Call Girl Service Available
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
 
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
 
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
 
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappMost Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
 
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
 
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
 
Call Girls Guntur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Guntur  Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Guntur  Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Guntur Just Call 8250077686 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
 

Ischemic Colitis