Volvulus Flashcards

1
Q

Definition of volvulus

A

A volvulus can be defined as a rotation of a loop of bowel around the axis of its mesentery that results in compromised blood flow and closed loop bowel obstruction which can lead to ischaemia

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2
Q

Aetiology of volvulus

A

• The areas usually affected:
• SIGMOID volvulus (80% of cases):
◦ Large bowel obstruction caused by sigmoid colon twisting on sigmoid mesocolon

					• Caecal volvulus (20% of cases):
						◦  Usually due to developmental failure that increases risk of caecal volvulus
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3
Q

Risk factors for sigmoid volvulus

A

◦ Older patients
◦ Chronic constipation
◦ Neurological conditions (e.g Parkinson’s)
◦ Chagas’ disease
◦ Long mesentery/ long sigmoid colon

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4
Q

Risk factors for caecal volvulus

A

◦ All ages
◦ Adhesions
◦ Pregnancy
◦ Mobile caecum

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5
Q

Pathophysiology of volvulus

A

• The bowel twisting upon its own mesentery can reduce the blood flow to the bowel and greatly increase the risk of bowel ischaemia
• Moreover, it would create a strangulating closed loop bowel obstruction

• If the twisting of the colon also affects the superior mesenteric artery, the small intestine and a portion of the colon can become ischaemic

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6
Q

History and Examination of volvulus

A

• Absolute constipation: earlier sign if large bowel affected
• Nausea/vomiting: earlier sign of small bowel volvulus (can be bilious)
• Abdominal pain: SEVERE and SUDDEN onset, can be colicky
• Abdominal distention
• Abdominal tenderness
• Tachycardic
• May have absent or tinkling bowel sounds

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7
Q

Investigations for volvulus

A

• FBC
• U&Es
• CT scan Abdomen and Pelvis with contrast:
◦ Can identify the site and cause +more sensitive
◦ Would show dilated sigmoid colon with ‘whirl sign’ due to twisting of mesentery around base

• Abdominal X-Ray: Likely to show large, dilated loop of colon. Can see a COFFEE-BEAN sign arising from left iliac fossa

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8
Q

Treatment of volvulus

A

Stable patient:
1) Treat conservatively initially:
◦ Most patients treated conservatively with DECOMPRESSION by rigid sigmoidoscopy and insertion of a flatus tube (left in situ for up to 24 hours)

+ Supportive care: NG tube, IV fluid resuscitation

Obstruction with ischaemia (unstable):
◦ If unstable, suspected ischaemia, failed conservative management etc
◦ OPEN LAPAROTOMY: with Hartman’s procedure, check for ischaemic bowel and remove

+ Supportive care: NG Tube and aggressive IV fluid resuscitation

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9
Q

Complications of volvulus

A

• Bowel ischaemia leading to necrosis, perforation and fatal peritonitis
• Bowel resection related short gut syndrome: due to loss of bowel
• Adhesions due to surgery

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10
Q

Prognosis of volvulus

A

Prognosis depends on degree of intestinal ischaemia and necrosis
There is a slight risk of recurrence

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