Volvulus

Question 1

Volvulus

Answer 1

Volvulus may be defined as torsion of the colon around it’s mesenteric axis resulting in compromised blood flow and closed loop obstruction.

Sigmoid volvulus (around 80% of cases) describes large bowel obstruction caused by the sigmoid colon twisting on the sigmoid mesocolon. A similar problem may also occur at the caecum (20% of cases). In most people (around 80%) the caecum is a retroperitoneal structure so not at risk of twisting. In the remaining minority there is however developmental failure of peritoneal fixation of the proximal bowel putting these patients at risk of caecal volvulus.

Question 2

Sigmoid Volvulus - Associations

Answer 2

Older patients
Chronic constipation
Chagas disease
Neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
Psychiatric conditions e.g. schizophrenia

Question 3

Caecal Volvulus - Associations

Answer 3

All ages
Adhesions
Pregnancy

Question 4

Volvulus - Fx, Diagnosis and Mx

Answer 4

Features
constipation
abdominal bloating
abdominal pain
nausea/vomiting

Diagnosis
usually diagnosed on the abdominal film
sigmoid volvulus: large bowel obstruction (large, dilated loop of colon, often with air-fluid levels) + coffee bean sign
caecal volvulus: small bowel obstruction may be seen

Management
sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
caecal volvulus: management is usually operative. Right hemicolectomy is often needed