Volvulus Flashcards
what is volvulus?
torsion of the colon around its mesenteric axis resulting in compromised blood flow and closed loop obstruction
what is the most common type of volvulus?
sigmoid
what is a sigmoid volvulus?
large bowel obstruction caused by the sigmoid colon twisting on the sigmoid mesocolon
why is caecal volvulus less common than sigmoid volvulus?
for most people caecum is a retroperitoneal structure so not at risk of twisting
what are the assocaitions of caecal volvulus?
- all ages
- adhesions
- pregnancy
what are the assocaitions of sigmoid volvulus?
- older patients
- chronic constipation
- chagas disease
- neurological conditions
- psychiatric conditions
what are the features of volvulus?
- constipation
- abdominal pain
- abdominal bloating
- nausea/vomiting
what investigations are done in volvulus?
abdominal film
what is seen on x-ray in sigmoid volvulus?
large bowel obstruction
(large, dilated loop of colon, often with air-fluid levels)
coffee bean sign
what is seen on x-ray in caecal volvulus?
small bowel obstruction
(valvulae conniventes, mucosal folds, that cross the full width of the bowel)
what is the management of sigmoid volvulus?
rigid sigmoidscopy with rectal tube insertion
what is the management of caecal volvulus?
operative
right hemicolectomy is often needed
