Volvulus (2*)

Question 1

What occurs here?
→ What does it lead to?

What are the types?

What is there a high risk of here? Why?

Answer 1

➊ Bowel twists around itself and the mesentery attached
→ Closed-loop bowel obstruction

➋ • Sigmoid – More common and tends to affect older pts – Key cause is chronic constipation, and associated with high-fibre diet and excessive use of laxatives
• Caecal – Less common and tends to affect younger pts

➌ Ischaemia, necrosis, and perforation as mesentery contains the gut’s blood supply

Question 2

How does it present?

Answer 2

• Abdominal distension
• Absolute constipation
• Diffuse abdominal pain
• Bilious vomiting

Question 3

Which investigations may be done?

How is it managed?

Answer 3

➊ • XR – Coffee bean sign
• Contrast CT – Confirms diagnosis and shows other pathologies

➋ • Same as with bowel obstruction – NBM, NGT, IVF
• Endoscopic decompression – Risk of reoccurrence
• Ileocaecal resection or Right hemicolectomy for caecal volvulus