Volvulus Flashcards
Sigmoid volvulus pathophysiology
- Twisting of a loop of intestine
- Long mesentery with narrow base predisposes to torsion
- → closed loop obstruction
Presentation of sigmoid volvulus
- Colicky pain
- Massive distension with tympanic abdomen - gas filled
- Absolute constipation
Sign of sigmoid volvulus on AXR
Coffee bean sign
Management of sigmoid volvulus
• Sigmoidoscopy and flatus tube insertion - decompression
- Monitor for signs of bowel ischaemia following
decompression. - Sigmoid colectomy occasionally required
- Often reoccurs - elective sigmoidectomy
Indication for sigmoid colectomy
- Failed repeated endoscopic decompression
- Bowel necrosis
- Perforation
Caecal volvulus
- Congenital malformation where caecum is not fixed in the RIF
- Typically requires surgery
Risk factors for gastric volvulus
Congenital
- Bands
- Rolling / Paraoesophageal hernia
- Pyloric stenosis
• Acquired
- Gastric / oesophageal surgery
- Adhesions
Management of gastric volvulus
- Endoscopic manipulation
* Emergency laparotomy
Risk Factors
Age
Neuropsych: MS
Resident in nursing home
Chronic constipation or laxative use - sigmoid elongation
Male
Previous abdominal operations
Investigations
Abdominal examination
Routine bloods
- Ca2+ and TFTs to rule out pseudo obstruction
- CT abdomen and pelvis with contrast
Mx of caecal volvulus
Laparotomy and ileocaecal resection
• Right hemicolostomy with ileocolic anastomosis
Borchardt’s triad
Gastric volvulus can present as:
- Severe epigastric pain
- Retching without vomiting
- Inability to pass an NG tube