Volvulus (Colonic)

Question 1

def

Answer 1

rotation of a loop of bowel around the axis of its mesentry which results in bowel obstruction and potentially ischaemia

Question 2

what areas are usually affected by volvulus?

Answer 2

sigmoid colon (65%)
caecum (30%)

Question 3

aetiology

Answer 3

1 anatomical factors
-long sigmoid mesentry
-mobile caecum
2 chronic constipation
3 adhesions (surgery)

Question 4

what infection can cause colonic volvulus

Answer 4

chagas disease of the colon

Question 5

epi

Answer 5

causes 5-10% of large bowel obstruction

elderly

Question 6

history

Answer 6

1 abdominal pain + swelling
2 absolute constipation
3 later vomiting

Question 7

pathogenesis

Answer 7

rotation of segment of bowel causes loop obstruction
bowel is compressed and occluded which causes ischaemia
gangrene and perforation can occur

Question 8

examination

Answer 8

1 signs of bowel obstruction and tenderness

2 tinkling/absent bowel sounds

Question 9

investigations

Answer 9

1 AXR
-massively dilated bowel with ‘coffee bean’ shape
2 water-soluble contrast enema
-for site of obstruction

Question 10

what is indicated when the ‘coffee bean’ points towards the RLQ

Answer 10

caecal volvulus

Question 11

what is indicated when the ‘coffee bean’ points towards the LLQ

Answer 11

sigmoid

Question 12

what would be seen on a water-soluble contrast enema in sigmoid volvulus

Answer 12

‘bird’s beak’ or ‘ace of spades’ with spiral narrowing of distal bowel