Volvulus Flashcards

1
Q

What is a volvulus?

A

Bowel twists around itself and the mesentery it is attached to

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2
Q

What can twisting in the bowel lead to?

A

Closed-loop bowel obstruction

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3
Q

Who tends to be affected by sigmoid volvulus?

A

Older patients

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4
Q

What is a key cause of a sigmoid volvulus?

A

Chronic constipation and lengthening of the mesentery attached to the sigmoid colon

Sigmoid becomes overloaded with faeces causing it to twist

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5
Q

What is a sigmoid volvulus associated with?

A

Chronic constipation

High-fibre diet

Excessive laxative use

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6
Q

Who tends to be affected by a caecal volvulus?

A

Younger patients

Less common

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7
Q

What are the risk factors of developing a volvulus?

A

Neuropsychiatric disorders (e.g. parkinson’s)

Nursing home residents

Chronic constipation

High fibre diet

Pregnancy

Adhesions

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8
Q

How does a volvulus present?

A

Green bilious vomiting

Abdominal distention

Diffuse abdominal pain

Absolute constipation and lack of flatulence

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9
Q

How is a volvulus diagnosed?

A

Abdominal x-ray can show coffee bean sign in a sigmoid volvulus

Contrast CT

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10
Q

How is a volvulus managed initially?

A

Conservative management with endoscopic decompression attempted first

Flexible sigmoidoscope to correct sigmoid volvulus

Flatus tube left in place to help decompress the bowel later as 60% chance of recurring

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11
Q

What is the surgical management of a volvulus?

A

Laparotomy

Hartmann’s procedure (removal of rectosigmoid colon and formation of a colostomy) anorectal stump

Ileocaecal resection or right hemicolectomy for caecal volvulus

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