Volvulus

Question 1

Volvulus

Answer 1

Torsion of the colon around its mesenteric axis

Results in compromised blood flow and closed loop obstruction

Question 2

Sigmoid volvulus

Answer 2

Moore common and tends to affect older patients

Twist affects the sigmoid colon

Question 3

Sigmoid volvulus associations

Answer 3

Chronic constipation

Chagas disease

Neurological conditions (Parkinson’s, Duchenne)

Psychiatric conditions (schizophrenia)

Question 4

Caecal volvulus

Answer 4

Less common and tends to affect younger patients

Question 5

Coaecal volvulus associations

Answer 5

Adhesions

Pregnancy

Question 6

Presentation

Answer 6

Vomiting (particularly green bilious vomiting)

Abdominal distention

Diffuse abdominal pain

Absolute constipation

Question 7

Diagnosis

Answer 7

Usually diagnosed on abdominal film

Sigmoid: large bowel obstruction and coffee bean sign

Caecal volvulus: small bowel obstruction may be seen

Question 8

Sigmoid volvulus management

Answer 8

Rigid sigmoidoscopy with rectal tube insertion

Question 9

Caecal volvulus management

Answer 9

Usually operative

Right hemicolectomy often needed