Volvulus Flashcards
What is a volvulus?
Twisting of the intestine around itself and the mesentery that supports it.
What are the risk factors of volvulus? (x7)
o Congenital intestinal malrotation
o An enlarged colon
o Hirschsprung disease (congenital defect where nerves are missing from parts of the intestine)
o Pregnancy
o Abdominal adhesions
o Constipation
o High fibre diet
What are the most commonly affected areas in volvulus?
Sigmoid and caecum. In children, the small intestines are most often involved.
What is the epidemiology of volvulus: Where? Age? Gender?
More common in Africa, the Middle East and India. Typically 30-70y/o. Men.
What are the mechanisms of symptoms in volvulus?
From bowel obstruction and from ischaemia
What are the symptoms and signs of volvulus?
o BOWEL OBSTRUCTION: abdominal distension, tenderness, colicky pain, lack of stool or flatus, bilious vomiting. **Though depends on location – sigmoid volvulus may not see lack of stool/flatus and would instead see constipation.
o ISCHAEMIA: colicky abdominal pain, shock, acidosis from necrosis (lactic acid),
o [Please see intestinal ischaemia and intestinal obstruction notes]
What are the investigations of volvulus? (x3) Differentials that need investigating? (x3)
o AXR: ‘coffee bean’ sign is most common aka ‘bent inner tube’ sign.
o Barium enema: if diagnosis is in doubt; shows a ‘bird’s beak’ at the point where the proximal vowel and distal bowel rotate to form the volvulus
o CT scan
o Be aware of other, more common causes of obstruction e.g. malignancy (endoscopy), diverticulitis (CT scan), IBD…
When is barium enema contraindicated when investigating for volvulus? What can be used instead?
When a perforation is suspected as it could be lethal when distributed intraperitoneally. Gastrografin is safer (contrast agent).
