Volvulus Flashcards
What is a volvulus
Twisting of loop of intestine around its mesentery
What can be the complication of volvulus
As the mesentery has the blood supply in it, a twisting on that can compromise the blood supply which can rapidly lead to bowel necrosis and perforation
Where is the most common area in the GI tract to get a volvulus
Sigmoid colon
Why is the sigmoid colon prone to volvulus
It has a long mesentery which makes in prone to twist on itself
What are the risk factors of volvulus
Increasing age
Neuropsychiatric disorders
Resident in a nursing home
Chronic constipation or laxative use
Male gender
Previous abdominal operations
What are the clinical features of a volvulus
Present with features of bowel obstruction:
Colicky pain
Abdominal distension
Absolute constipation
Vomiting
( if there has been a perforation there will be signs of peritonism)
What are the differential diagnosis of volvulus
Severe constipation
Pseudo-obstruction
Diverticular disease
What are the lab investigations that you would carry out if volvulus is suspected
Routine bloods U&Es Ca2+ TFTs ( above can rule out pseudo-obstruction)
Which imaging modalities would you use to investigate volvulus
CT AP with constrast ( will see a whirl sign )
AXR will show coffee bean sign
What is the immediate management of a patient with volvulus
Fluid resus if vital signs not stable
Examine for signs of ischaemia
What are the conservative management options available for volvulus
Decompression by sigmoidoscope
Insertion of flatus tube which is left in for a period of time even after the decompression to allow for continuous passage of contents and to aid recovery
If above is unsuccessful then they use a flexible sigmoidscope
What are the indications for surgery of volvulus
Colonic ischaemia or perforation
Repeated failed attempts at decompression
Necrotic bowel noted at endoscopy
What options are there for patients with recurrent volvulus
sigmoidectomy with primary anastomosis to prevent further recurrence.
What are the complications of a sigmoid volvulus
Bowel ischaemia
Perf
Risk of recurrence
Mortality from surgery
What is the 2nd most common site for a volvulus to occur
Caecum
