Volvulus

Question 1

What is volvulus?

Answer 1

rotation of a loop of bowel around the axis of its mesentery that results in bowel obstruction and potential ischaemia

Question 2

Where do most volvulus occur?

Answer 2

• Sigmoid colon 65%

- Caecum 30%

Question 3

What are RF for volvulus?

Answer 3

1. Long sigmoid colon
2. Long mesentery
3. Mobile caecum
4. Chronic constipation
5. Adhesions
6. Parasitic infections
7. Neonates: malrotation

Question 4

What are symptoms of volvulus?

Answer 4

1. Severe colicky pain
2. Vomiting
3. Abdo distention and tenderness
4. Signs of dehydration
5. Absent/tinkling bowel sounds
6. Constipation

Question 5

What is the management of a sigmoid volvus?

Answer 5

1. Sigmoidoscopy with detorsion
   o If no suspicion of ischaemia or perforation
   o 75-95% success
   o Recurrence 84% - need to do surgery after detorsion to prevent

Question 6

What is the management of a caecal volvulus?

Answer 6

• Colonoscopy and detorsion not done – risk of perforation

* Need to perform surgery