Volvulus

Question 1

what is the typical presentation of volvulus?

Answer 1

bilious emesis

abdo pain

colicky pain

constipation

tinkling bowel sounds

Question 2

define volvulus?

Answer 2

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

Question 3

outline the aetiology/ risk factors of volvulus in adults?

Answer 3

• Long sigmoid colon
• Long mesentery
• Mobile caecum (failure of caeucum)
• Chronic constipation
• Adhesions
• Chagas disease (parasitic disease)
• Parasitic infections

Question 4

what is the cause of volvulus in neonates?

Answer 4

Malrotation: incomplete rotation of the midgut causing a failure in the attachment of the caecum to the posterior abdominal wall

Question 5

what are the presenting symptoms of volvulus?

Answer 5

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 6

what are the signs of voluvulus on physical examination?

Answer 6

Signs of bowel obstruction with abdominal distension and tenderness

tinkling bowel sounds (intestinal obstruction)

Fever

Tachycardia

Signs of dehydration

Question 7

what are the investigations for volvulus?

Answer 7

AXR-coffee bean sign

• sigmoid volvulus- coffee bean sign
• foetus sign- caecal

Erect CXR- if perforation suspected

water soluble contrast enema- if bowel obstruction suspected

CT scan