volvulus Flashcards
what
bowel twists round itself and the mesentery it is attached to
leads to closed loop bowel obstruction
blood supply cut off –> ischamia, necrosis, perforatoin
sigmoid volvulus
more common, affects older patients
key cause = constipation
sigmoid colon becomes full of faeces, it sinks downwards and so twists
caecal volvulus
less common, younger patients
twist occurs in caecum
risk factors
neuropsychiatric disorders e.g. parkinsons nursing home residents chronic constipation high fibre diet pregnancy adhesions
presentation
vomiting (esp bilious)
abdo distension
diffuse abdo pain
absolute constipation
sign of sigmoid volvulus on abdo x-ray
coffee bean sign
- dilated and twisted sigmoid colon looks like a giant coffee bean
investigation of choice
contrast CT scan
initial Mx
NBM
NG tube
IV fluids
conservative Mx for sigmoid volvulus
endoscopic decompression can be attempted
flexible sigmoidoscope inserted to correct
surgical management
laparotomy
hartmann’s procedure for sigmoid volvuluc
ileocaecal resection or right hemicolectomy for caecal volvulus
hartmann’s procedure
removal of rectosigmoid colon and formation of a colostomy