Volvulus Flashcards

1
Q

Sigmoid volvulus pathophysiology

A
  • Twisting of a loop of intestine
  • Long mesentery with narrow base predisposes to torsion
  • → closed loop obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Presentation of sigmoid volvulus

A
  • Colicky pain
  • Massive distension with tympanic abdomen - gas filled
  • Absolute constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sign of sigmoid volvulus on AXR

A

Coffee bean sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management of sigmoid volvulus

A

• Sigmoidoscopy and flatus tube insertion - decompression

  • Monitor for signs of bowel ischaemia following
    decompression.
  • Sigmoid colectomy occasionally required
  • Often reoccurs - elective sigmoidectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Indication for sigmoid colectomy

A
  • Failed repeated endoscopic decompression
  • Bowel necrosis
  • Perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Caecal volvulus

A
  • Congenital malformation where caecum is not fixed in the RIF
  • Typically requires surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Risk factors for gastric volvulus

A

Congenital

  • Bands
  • Rolling / Paraoesophageal hernia
  • Pyloric stenosis

• Acquired

  • Gastric / oesophageal surgery
  • Adhesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of gastric volvulus

A
  • Endoscopic manipulation

* Emergency laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk Factors

A

Age

Neuropsych: MS

Resident in nursing home

Chronic constipation or laxative use - sigmoid elongation

Male

Previous abdominal operations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Investigations

A

Abdominal examination

Routine bloods
- Ca2+ and TFTs to rule out pseudo obstruction

  • CT abdomen and pelvis with contrast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mx of caecal volvulus

A

Laparotomy and ileocaecal resection

• Right hemicolostomy with ileocolic anastomosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Borchardt’s triad

A

Gastric volvulus can present as:

  • Severe epigastric pain
  • Retching without vomiting
  • Inability to pass an NG tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly