Volvulus

Question 1

What is volvulus and what are the consequences?

Answer 1

Bowel twists around itself on its mesentery leading to closed-loop bowel obstruction and possible necrosis due to blood vessels in mesentery being occluded

Question 2

What are the risk factors for volvulus?

Answer 2

Parkinsons
Nursing home residents 
Chronic constipation 
High fibre diet
Pregnancy 
Adhesions

Question 3

How would someone with volvulus present?

Answer 3

Vomiting- green bilious 
Abdo distention 
Diffuse abdo pain 
Absolute constipation 
Lack of flatulence

Question 4

What are the 2 main types of volvulus? Who is most at risk for each?

Answer 4

Sigmoid
-elderly people

Caecal (less common)
-younger patients

Question 5

What causes sigmoid volvulus?

Answer 5

Chronic constipation= causes sigmoid to be overloaded with faeces and sink == causes twist

High fibre diet
Excessive laxative use

Question 6

How do you diagnose sigmoid volvulus?

Answer 6

AXR= coffee bean sign (sigmoid volvulus)

Contrast CT= confirms diagnosis

Question 7

How would someone with volvulus be managed conservatively?

Answer 7

NBM
NG tube
IV fluids
Flexible sigmoidoscope used to attempt endoscopic decompression

Question 8

How can someone with volvulus be managed surgically?

Answer 8

Laparotomy
Sigmoid->Hartmann’s procedure= removal of rectosigmoid colon and formation of colostomy

Caecal-> Ileocaecal resection or right hemicolectomy