Volvulus Flashcards
What is a volvulus?
Bowel twists around itself and the mesentery it is attached to
What can twisting in the bowel lead to?
Closed-loop bowel obstruction
Who tends to be affected by sigmoid volvulus?
Older patients
What is a key cause of a sigmoid volvulus?
Chronic constipation and lengthening of the mesentery attached to the sigmoid colon
Sigmoid becomes overloaded with faeces causing it to twist
What is a sigmoid volvulus associated with?
Chronic constipation
High-fibre diet
Excessive laxative use
Who tends to be affected by a caecal volvulus?
Younger patients
Less common
What are the risk factors of developing a volvulus?
Neuropsychiatric disorders (e.g. parkinson’s)
Nursing home residents
Chronic constipation
High fibre diet
Pregnancy
Adhesions
How does a volvulus present?
Green bilious vomiting
Abdominal distention
Diffuse abdominal pain
Absolute constipation and lack of flatulence
How is a volvulus diagnosed?
Abdominal x-ray can show coffee bean sign in a sigmoid volvulus
Contrast CT
How is a volvulus managed initially?
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
What is the surgical management of a volvulus?
Laparotomy
Hartmann’s procedure (removal of rectosigmoid colon and formation of a colostomy) anorectal stump
Ileocaecal resection or right hemicolectomy for caecal volvulus
