Volvulus

Question 1

Define volvulus

Answer 1

Rotation of a loop of bowel around the axis of its mesentery that results in bowel obstruction and potential ischaemia. The areas usually affected in adults are the sigmoid colon (65%) and caecum (30%). In neonates (volvulus neonatorum), midgut volvulus is more common

Question 2

What are the causes/risk factors of volvulus?

Answer 2

• Anatomical factors:  
- Long mesentery 
- Long Sigmoid Colon 
- Mobile Caecum 
• Adhesions  
• Tumour 
• Chagas’ disease of the colon and Parasitic infections 

Volvulus neonatorum:
• It is due to malrotation of the embryonic gut during development.
• Ladd’s bands: peritoneal bands from the caecum to the posterior abdominal wall that cross over the duodenum.

Question 3

What are the symptoms of volvulus?

Answer 3

• Severe colicky abdominal pain
• Abdominal swelling
• Absolute constipation
• Vomitting due to intestinal obstruction

*Neonatal volvulus presents at 3 months with distress due to pain and bile-stained vomiting

Question 4

What are the signs of volvulus?

Answer 4

• Fever
• Tachycardia
• Dehydration (dry mouth)
• Abdominal tenderness
• Abdominal distension
• Obstruction - absent/ frequent high pitched tinkling bowel sounds

Question 5

What investigations are carried out for volvulus?

Answer 5

• AXR - coffee bean sign: singly dilated loop of bowel
- In caecal volvulus, the concavity of the coffee bean points to the right; in sigmoid volvulus, it points to the left.
- May show proximal bowel dilation and distal collapse.
• Erect CXR - shows pneumoperitoneum if perforation is suspected.
• CT Scan - can identify rotation and torsion of mesentery and bowel as well as signs suggestive of infarction.
• Water-Soluble Contrast Enema - demonstrates the site of obstruction
- In sigmoid volvulus, there is a ‘bird’s beak’ or ‘ace of spades’ deformity with spiral narrowing of the distal bowel at the site.
• ECG - tachycardia
• Full history
• FBC – crp, esr, lft , amylase U+E, WCC. Stool culture, clotting,