Volvulus

Question 1

define it?

Answer 1

rotation of a loop of small bowel around the axis of its mesentery that results in bowel obstruction and potential ischaemia.

Question 2

Which part of intestines are affected?

Answer 2

Sigmoid colon - 65%

Caecum - 30%

Volvulus Neonatorum - occurs in neonates and typically affects the midgut

Question 3

What are the risk factors?

Answer 3

Anatomical factors (e.g. long mesentery)

Adults;
Long sigmoid colon 
Long mesentery  
Mobile caecum  
Chronic constipation  
Adhesions 
Chagas disease 
Parasitic infections  

Neonatal;
Intestinal Malrotation

Question 4

What are the presenting symptoms?

Answer 4

Severe colicky abdominal pain and swelling

Absolute constipation

Vomiting

There may be a history of transient attacks in which spontaneous reduction of the volvulus has occurred

Neonatal volvulus presents around 3 months

Question 5

Signs of volvulus on examination?

Answer 5

Signs of bowel obstruction with abdominal distension and tenderness

Absent or tinkling bowel sounds

Fever

Tachycardia

Signs of dehydration

Question 6

Appropriate investigations?

Answer 6

Bloods:

1. Full workup including G&C, x-match ahead of surgery.
2. ABG - metabolic acidosis
3. FBC: inc WCC

Imaging:
1. Urgent CT Scan (bmj) - with contrast
2.  Abdominal xray
----------------
Water-soluble contrast enema?? (can be considered)
  - Shows site of obstruction

Question 7

mx?

Answer 7

depends on cause but:

supportive
NG tube bowel decompression
Surgery: Elective LADD procedure

Obstructed:
If uncomplicated - urgent surgery with LADD procedure
if complicated - emergency procedure

Question 8

what will be seen on xray with volvulus?

Answer 8

Sigmoid - Coffee bean sign

Caecal - no such sign just dilated bowel.