Volvulus Flashcards
1
Q
What is a volvulus?
A
- Twisting of a loop of bowel
- Around its mesenteric attachment
2
Q
Why is a volvulus bad?
A
- Surgical emergency
- Closed loop bowel obstruction forms within affected segment
- Compromise of blood supply due to twisting
- Rapidly leads to bowel necrosis and perforation
3
Q
Where do most volvulus occur and why?
A
- Sigmoid colon due to its long mesentery
- = prone to twist
- Other sites inc stomach, caecum, small intestine and transverse colon
4
Q
RF for volvulus
A
- Advanced age
- Neurological disorders eg Parkinsons or vascular dementia
- Psychiatric disease - on antipsychotics esp
- Reduced mobility
- Male
5
Q
Why are all these risk factors increasing the risk?
A
- Increase chance of chronic constipation and slow transit time
- = redundant sigmoid colon (longer than space to fit)
- = prone to twist
6
Q
Symptoms of sigmoid volvulus
A
- Abdominal distension
- Absolute constipation
- Varying degrees of abdominal pain
- Then vomitting secondary to obstruction later
7
Q
Compared to other causes of bowel obstruction, how do symptoms differ?
A
- Rapid onset - over a few hours
- Degree of abdominal distension - very
8
Q
Examination of volvulus
A
- Distended abdomen
- Tympanic to percussion
- Localised tenderness
- Peritonism = ?bowel ischaemia developing
9
Q
Sigmoid volvulus x-ray
A
Often done first line even though less sensitive than CT
10
Q
Management of all patients with volvulus
A
- IV fluids - resuscitation
- NG tibe esp if vomitting
- Urinary cathter for fluid balance
- Analgesia
- Correct electrolytes
11
Q
Bedside and bloods for ?volvulus
A
- FBC
- U&E
- CRP
- Clotting screen
- VBG - pH and lactate - bowel ischaemia?
12
Q
Imaging for volvulus sigmoid
A
- CT abdomen pelvis + IV contrast
- = very dilated sigmoid colon with whirl sign
- Also allows to check for bowel ischaemia, if ileocaecal valve is incompetent = signs of SBO
13
Q
Conservative management sigmoid volvulus
A
- Decompression via sigmoidoscope and insertion of flatus tube
14
Q
How is sigmoidoscope decompression done?
A
- Patient placed in left lateral position
- Lubricated sigmoidoscope into rectum - often need to use flexible one instead of rigid as difficult
- Manoeuvered to locate the twisted bowel
- Gentle pressure to untwist the volvulus
- When in correct position - rush of air and liquid faeces as obstruction is relieved
15
Q
What is the flatus tube for?
A
- Left in situ for up to 24hrs after initial decompression
- Allows for continued passage of contents and aid recovery of affected area
