Volvulus Flashcards
What is volvulus?
Torsion of the colon around itself and the mesentery that it is attached to
What complication does volvulus lead to?
Closed loop bowel obstruction - a section of bowel is isolated by obstruction on either side
What are the two main types of volvulus?
Sigmoid volvulus - most common
Caecal volvulus
What are the risk factors for volvulus?
Neuropsychiatric disorders
Nursing home residents
Chronic constipation
High fibre diet
Pregnancy
Adhesions
What is the clinical presentation of volvulus?
Vomiting - bilious
Abdominal distention
Diffuse abdominal pain
Constipation
Lack of flatulence
What initial investigation is used in the diagnosis of volvulus?
Abdominal XR
What is seen on XR in volvulus?
Coffee bean sign in sigmoid volvulus
What is the gold standard investigation for diagnosis of volvulus?
Contrast CT scan
What is the management of volvulus?
Same as bowel obstruction:
- NBM
- NG tube
- IV fluids
Endoscopic decompression (sigmoid volvulus), using a flexible sigmoidoscope
What is the surgical management of volvulus?
Laparotomy
Hartmann’s procedure - removal of rectosigmoid colon and formation of colostomy
Ileocecal resection or right hemicolectomy for caecal volvulus