Volvulus

Question 1

What is volvulus?

Answer 1

Condition where the bowel twists around itself and the mesentery that it is attached to

Question 2

Twisting in the bowel leads to a closed-loop bowel obstruction - what is this?

Answer 2

A section of bowel is isolated by obstruction on either side

Question 3

Blood supply to the bowel can be cut off, resulting in an ischaemia - what 2 things can an ischaemia cause?

Answer 3

Necrosis of bowel and bowel perforation

Question 4

1) What are the 2 types of volvulus?
2) Which is the most common?
3) Which occurs mainly in younger people and which occurs mainly in older people?

Answer 4

1) Sigmoidal and caecal
2) Sigmoidal
3) Sigmoidal in older patients and caecal in younger

Question 5

Name 2 causes of a sigmoid volvulus

Answer 5

• Chronic constipation
• Lengthening of the mesentery attached to the sigmoid colon
• High fibre diet
• Excessive laxative use

Question 6

Name 2 risk factors for volvulus

Answer 6

• Neuropsychiatric disorders (e.g., Parkinson’s)
• Nursing home residents
• Chronic constipation
• High fibre diet
• Pregnancy
• Adhesions

Question 7

1) The signs and symptoms of volvulus are similar to what?
2) Name 2 of these signs and symptoms

Answer 7

1) Bowel obstruction
2) Vomiting (particularly green bilious vomiting), abdominal distention, diffuse abdominal pain, absolute constipation and lack of flatulence

Question 8

1) What can be seen on an abdominal x-ray that is a sign of a sigmoid volvulus?
2) What is the investigation of choice to confirm diagnosis?

Answer 8

1) Coffee bean sign
2) Contrast CT scan

Question 9

1) What is the conservative management of a sigmoid volvulus?
2) Name a surgical intervention for a sigmoid volvulus
3) Name a surgical intervention for a caecal volvulus

Answer 9

1) Endoscopic decompression of the volvulus
2) Rigid sigmoidoscopy with rectal tube insertion
3) Ileocaecal resection or right hemicolectomy