Volvulus

Question 1

Define volvulus

Answer 1

Rotation of a loop of small bowel around the axis of mesentery that results in bowel obstruction & potential ischaemia

Question 2

Aetiology of volvulus

Answer 2

Anatomical factors (e.g. long mesentery)

Question 3

Risk factors for volvulus - adults

7

Answer 3

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

Question 4

Risk factors for volvulus - neonates

Answer 4

Malrotation

Question 5

Presenting symptoms of volvulus

5

Answer 5

Severe colicky abdo pain & swelling
Absolute constipation
Vomiting
May be history of transient attack in which spontaneous reduction of volvulus has occurred
Neonatal volvulus presents around 3 months

Question 6

Signs of volvulus on physical examination

5

Answer 6

Signs of bowel obstruction w/ abdominal distention & tenderness
Absent or tinkling bowel sounds
Fever
Tachycardia 
Signs of dehydration

Question 7

Investigations for volvulus

4

Answer 7

AXR

Erect CXR
If perforation suspected

Water-soluble contract enema
Shows site of obstruction

CT scan

Question 8

Areas affected by volvulus

3

Answer 8

Sigmoid colon - 65%
Caecum - 30%
Volvulus neonatorum - occurs in neonates & typically affects midgut