volvulus Flashcards

1
Q

what

A

bowel twists round itself and the mesentery it is attached to

leads to closed loop bowel obstruction
blood supply cut off –> ischamia, necrosis, perforatoin

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2
Q

sigmoid volvulus

A

more common, affects older patients
key cause = constipation

sigmoid colon becomes full of faeces, it sinks downwards and so twists

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3
Q

caecal volvulus

A

less common, younger patients

twist occurs in caecum

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4
Q

risk factors

A
neuropsychiatric disorders e.g. parkinsons
nursing home residents
chronic constipation 
high fibre diet
pregnancy 
adhesions
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5
Q

presentation

A

vomiting (esp bilious)
abdo distension
diffuse abdo pain
absolute constipation

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6
Q

sign of sigmoid volvulus on abdo x-ray

A

coffee bean sign

  • dilated and twisted sigmoid colon looks like a giant coffee bean
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7
Q

investigation of choice

A

contrast CT scan

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8
Q

initial Mx

A

NBM
NG tube
IV fluids

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9
Q

conservative Mx for sigmoid volvulus

A

endoscopic decompression can be attempted

flexible sigmoidoscope inserted to correct

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10
Q

surgical management

A

laparotomy

hartmann’s procedure for sigmoid volvuluc

ileocaecal resection or right hemicolectomy for caecal volvulus

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11
Q

hartmann’s procedure

A

removal of rectosigmoid colon and formation of a colostomy

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