Volvulus

Question 1

What is a volvulus?

1 - small bowel becomes stuck to large bowel
2 - formation of an abnormal communication between 2 hollow organs
3 - pus filled area lined by epithelial cells
4 - twisting of bowel

Answer 1

4 - twisting of bowel

• normally twists around itself and mesentery
• can cause an obstruction

Question 2

A volvulus is an abnormal twisting of the intestines around itself and normally the mesentery, causing an obstruction. There are 3 main types, but which is the most common?

1 - sigmoid volvulus
2 - cecal volvulus
3 - midgut volvulus

Answer 2

1 - sigmoid volvulus
- accounts for up 8% of all bowel obstructions
- generally twists anticlockwise

Question 3

In addition to causing an obstruction, what else do volvulus cause that can be very dangerous?

1 - ischaemia
2 - vomiting and nausea
3 - malabsorption
4 - diarrhoea

Answer 3

1 - ischaemia

Question 4

2 of the main types of volvulus are sigmoid and cecal. We can tell which is which on a an X-ray. Out of sigmoid and cecal, which is associated with:

• coffee bean sign
• caecal embryo sign

Answer 4

• coffee bean sign = sigmoid
• caecal embryo sign = caecal

Question 5

What group of patients does a sigmoid volvulus tend to occur in?

1 - men <70 y/o
2 - women <70 y/o
3 - men >70 y/o
4 - women >70 y/o

Answer 5

3 - men >70 y/o

Question 6

Which of the following is NOT a typical risk factor for sigmoid volvulus?

1 - older age
2 - obesity
3 - chronic constipation
4 - neuropsychiatric disorder (MS, Parkinson, etc..)

Answer 6

2 - obesity

Question 7

There are a number of causes of a volvulus. Why can pregnancy cause a sigmoid volvulus in the mother?

1 - foetus causes displacement and twisting of colon
2 - constipation, where stool acts as a pivot point where bowels twist
3 - impaired peristalsis due to babies position
4 - increased abdominal adhesions that act as a pivot point for bowels to twist

Answer 7

1 - foetus causes displacement and twisting of colon

Question 8

There are a number of causes of a volvulus. What is the main cause of older patients getting a sigmoid volvulus?

1 - foetus causes displacement and twisting of colon
2 - constipation, where stool acts as a pivot point where bowels twist
3 - impaired peristalsis due to babies position
4 - increased abdominal adhesions that act as a pivot point for bowels to twist

Answer 8

2 - constipation, where stool acts as a pivot point where bowels twist

• older adults are more at risk of constipation

Question 9

There are a number of causes of a sigmoid volvulus. Why is previous surgery a risk for getting a sigmoid volvulus?

1 - foetus causes displacement and twisting of colon
2 - constipation, where stool acts as a pivot point where bowels twist
3 - impaired peristalsis due to babies position
4 - increased abdominal adhesions that act as a pivot point for bowels to twist

Answer 9

4 - increased abdominal adhesions that act as a pivot point for bowels to twist

Question 10

In a patient with a sigmoid volvulus, which of the following is NOT a symptom patients generally present with?

1 - distended abdomen
2 - diarrhoea
3 - LIF pain
4 - bloody stool

Answer 10

2 - diarrhoea

• incorrect, as it is normally associated with constipation

Question 11

If a patient has a volvulus, this can lead to ischaemia and an infarction. Which if the following does this NOT lead to?

1 - gangrene tissue
2 - perforation
3 - hypervolemia
4 - sepsis
5 - cardiovascular collapse

Answer 11

3 - hypervolemia

• incorrect, it could cause hypovolemia

Question 12

Up to 90% of patients with a sigmoid volvulus are diagnosed how?

1 - abdominal examination
2 - CT scan
3 - laparoscopic investigation
4 - X-ray

Answer 12

2 - CT scan

Question 13

When treating a sigmoid volvulus, what is often the most common treatment used?

1 - surgery to remove twisted sigmoid
2 - corticosteroids
3 - wait and see approach
4 - endoscopic decompression

Answer 13

4 - endoscopic decompression

Question 14

When treating a sigmoid volvulus, where endoscopic decompression has failed, what else can be performed?

1 - surgery
2 - corticosteroids
3 - wait and see approach
4 - laxatives

Answer 14

1 - surgery

• could be to resect, depending on severity or untwist bowel

Question 15

A caecum volvulus is more common in which group of patients?

1 - younger men
2 - younger females
3 - older men
4 - older women

Answer 15

2 - younger females

Question 16

What is the most common cause for a caecal volvulus?

1 - ileocaecal dysfunction
2 - appendicitis
3 - abnormal development of abdominal mesentery
4 - constipation

Answer 16

3 - abnormal development of abdominal mesentery
- attachments between GIT and mesentery are missing, so more likely to twist

Question 17

There are a number of clinical presentations that patients with a caecal volvulus can present with. Which of the following is NOT a typical presentation?

1 - intermittent or acute abdominal pain
2 - rapid onset of abdominal pain
3 - episodic cramping pain due to peristalsis
4 - nausea and vomiting
5 - obstipation (unable to defecate)

Answer 17

2 - rapid onset of abdominal pain

• this is wrong
  -it is normally a gradual onset

Question 18

When performing an abdominal examination in a patient with a suspected caecal volvulus, which of the following are we NOT likely to see?

1 - diffusely distended abdomen
2 - non tympanitic abdomen
3 - pain in LIF
4 - rebound tenderness

Answer 18

2 - non tympanitic abdomen
- bowels are normally non tympanic (gas filled)
- in volvulus they will contain lots of air, which us abnormal

Question 19

Up to 90% of patients with a caecal volvulus are diagnosed how?

1 - abdominal examination
2 - CT scan
3 - laparoscopic investigation
4 - X-ray

Answer 19

2 - CT scan

• remaining 10% is surgical

Question 20

In a patient who has a caecal volvulus that requires surgery, what is the most common surgery performed?

1 - right hemicolectomy
2 - left hemicolectomy
3 - subtotal colectomy
4 - low anterior resection

Answer 20

1 - right hemicolectomy

• anastomosis if safe to do so

Question 21

Which group of patients is a midgut volvulus most common in?

1 - young women
2 - men aged >70 y/o
3 - babies and small children
4 - pregnant women >40 y/o

Answer 21

3 - babies and small children

Question 22

A midgut volvulus is most common young babies and children. What is the main cause for this?

1 - abnormal development of GIT
2 - abnormal abdominal pressure during pregnancy
3 - abnormal abdominal pressure during pregnancy
4 - constipation

Answer 22

1 - abnormal development of GIT