Volvulus

Question 1

What is a volvulus?

Answer 1

A volvulus is when a loop of intestine twists around itself and its supporting mesentery, causing bowel obstruction and potentially compromising blood supply, leading to ischaemia

Question 2

Which parts of the bowel are most commonly affected by volvulus in adults?

Answer 2

The sigmoid colon (most common), followed by the caecum; in children, the small intestine is more often involved

Question 3

What are the classic symptoms of volvulus?

Answer 3

Sudden onset of colicky abdominal pain, abdominal distension, vomiting (may be bilious), constipation or obstipation, and sometimes bloody stool

Question 4

What are the signs of bowel ischaemia or perforation in volvulus?

Answer 4

Severe pain, fever, peritonism (tenderness, guarding, rigidity), tachycardia, hypotension, and shock

Question 5

What is the first-line investigation for suspected volvulus?

Answer 5

Plain abdominal X-ray, looking for the “coffee bean” sign in sigmoid volvulus

Question 6

What is the initial management of sigmoid volvulus without signs of ischaemia or perforation?

Answer 6

Attempt endoscopic decompression (flexible sigmoidoscopy or rectal tube)

Question 7

What is the definitive treatment for volvulus with ischaemia, perforation, or failed decompression?

Answer 7

Emergency surgery (bowel resection with or without stoma formation)
- laparotomy
- Hartmann’s procedure
- R hemicolectomy