Volvulus

Question 1

What is a volvulus?

Answer 1

Bowel twists around itself and the mesentery it is attached to

Question 2

What can twisting in the bowel lead to?

Answer 2

Closed-loop bowel obstruction

Question 3

Who tends to be affected by sigmoid volvulus?

Answer 3

Older patients

Question 4

Why is a sigmoid volvulus more common?

Answer 4

Long mesentery so more prone to twisting

Question 5

What is a key cause of a sigmoid volvulus?

Answer 5

Chronic constipation and lengthening of the mesentery attached to the sigmoid colon

Sigmoid becomes overloaded with faeces causing it to twist

Question 6

What is a sigmoid volvulus associated with?

Answer 6

Chronic constipation

High-fibre diet

Excessive laxative use

Question 7

Who tends to be affected by a caecal volvulus?

Answer 7

Younger patients

Less common

Question 8

What are the risk factors of developing a volvulus?

Answer 8

Neuropsychiatric disorders (e.g. parkinson’s)

Nursing home residents

Chronic constipation

High fibre diet

Pregnancy

Adhesions

Question 9

How does a volvulus present?

Answer 9

Green bilious vomiting

Abdominal distention

Diffuse abdominal pain

Absolute constipation and lack of flatulence

Question 10

How is a volvulus diagnosed?

Answer 10

Abdominal x-ray can show coffee bean sign in a sigmoid volvulus

Contrast CT Abdo-pelvis
Whirl sign

Question 11

How is a volvulus managed initially?

Answer 11

Need aggressive fluid resuscitation
NG tube
Catheter - fluid balance
Analgesia
Correct electrolytes

Question 12

What is the conservative management of a volvulus

Answer 12

Endoscopic decompression attempted first

Flexible sigmoidoscope to correct sigmoid volvulus

Flatus tube left in place to help decompress the bowel later as 60% chance of recurring

Question 13

What is the surgical management of a volvulus?

Answer 13

Laparotomy

Hartmann’s procedure (removal of rectosigmoid colon and formation of a colostomy) anorectal stump

Ileocaecal resection or right hemicolectomy for caecal volvulus