volvulus

Question 1

what

Answer 1

bowel twists round itself and the mesentery it is attached to

leads to closed loop bowel obstruction
blood supply cut off –> ischamia, necrosis, perforatoin

Question 2

sigmoid volvulus

Answer 2

more common, affects older patients
key cause = constipation

sigmoid colon becomes full of faeces, it sinks downwards and so twists

Question 3

caecal volvulus

Answer 3

less common, younger patients

twist occurs in caecum

Question 4

risk factors

Answer 4

neuropsychiatric disorders e.g. parkinsons
nursing home residents
chronic constipation 
high fibre diet
pregnancy 
adhesions

Question 5

presentation

Answer 5

vomiting (esp bilious)
abdo distension
diffuse abdo pain
absolute constipation

Question 6

sign of sigmoid volvulus on abdo x-ray

Answer 6

coffee bean sign

• dilated and twisted sigmoid colon looks like a giant coffee bean

Question 7

investigation of choice

Answer 7

contrast CT scan

Question 8

initial Mx

Answer 8

NBM
NG tube
IV fluids

Question 9

conservative Mx for sigmoid volvulus

Answer 9

endoscopic decompression can be attempted

flexible sigmoidoscope inserted to correct

Question 10

surgical management

Answer 10

laparotomy

hartmann’s procedure for sigmoid volvuluc

ileocaecal resection or right hemicolectomy for caecal volvulus

Question 11

hartmann’s procedure

Answer 11

removal of rectosigmoid colon and formation of a colostomy