Volvulus

Question 1

What is meant by the term “volvulus”?

Answer 1

Volvulus refers to a condition affecting the large bowel where the bowel twists around itself, resulting in a bowel obstruction

Question 2

What are the two main types of volvulus? Which is more common?

Answer 2

• Sigmoid volvulus (more common)

- Caecal volvulus

Question 3

Sigmoid volvulus tends to affect patients in which age group?

Answer 3

Older adults

Question 4

Give two risk factors for developing sigmoid volvulus (other than age)

Answer 4

• High fibre diet

- Excessive use of laxatives

Question 5

Describe the clinical features of volvulus

Answer 5

Signs/symptoms are akin to bowel obstruction:

• Abdominal pain and distension
• Nausea and vomiting (typically bilious)
• Absolute constipation and lack of flatulence

Question 6

Which initial imaging is typically performed in a case of suspected volvulus? What might this show in sigmoid volvulus?

What imaging may be done to confirm the diagnosis?

Answer 6

Abdominal XR - in sigmoid volvulus this might show the “coffee bean” sign

Contrast abdominal CT scan may be done to confirm the diagnosis

Question 7

Describe the initial and definitive management of volvulus

Answer 7

Initial management:

• NBM
• “Drip and suck” (IV fluids and NG tube)

Definitive management:

• Conservative, with endoscopic decompression using a flexible sigmoidoscope
• Surgical, e.g. Hartmann’s procedure for sigmoid volvulus