Volvulus

Question 1

Where in the bowel does volvulus usually occur

Answer 1

sigmoid volvulus- 80%
LBO caused by sigmoid colon twisting on the sigmoid mesocolon

Caecal volvulus
-rarer because a retroperitoneal structure which is not at risk of twisting

Question 1

What is volvulus

Answer 1

torsion of the colon around its mesenteric axis resulting in compromised blood flow and closed loop obstruction

Question 2

What is sigmoid volvulus associated with

Answer 2

older patients
chronic constipation
chagas disease
neurological conditions
psychiatric conditions

Question 3

What is caecal volvulus associated with

Answer 3

all ages
adhesions
pregnancy

Question 4

What may someone with volvulus present with

Answer 4

constipation
abdominal bloating
abdominal pain
nausea/ vomitting

Question 5

What investigations are required

Answer 5

Abdominal X-ray
- sigmoid volvulus - LBO so large dilated loops of colon and coffee bean sign

• caecal volvulus - SBO may be seen

Question 6

What management is required

Answer 6

sigmoid volvulus- sigmoidoscopy and passage of decompressing flatus tube

cecal volvulus - right hemicolectomy