Volvulus Flashcards
What is volvulus?
A condition where the bowel twists around itself and the mesentery it is attached to.
What is the function of the mesentery?
Connects bowel with posterior abdominal wall and provides blood supply to bowel via mesenteric arteries.
What occurs when the bowel twists in volvulus?
Leads to a closed-loop bowel obstruction.
What happens if blood vessels are involved in volvulus?
Cut off blood supply to bowel, leading to bowel ischaemia, necrosis, and perforation.
What are the two main types of volvulus?
- Sigmoid volvulus * Caecal volvulus
What is the most common cause of sigmoid volvulus?
- Chronic constipation with lengthening of mesentery
What happens to the sigmoid colon in sigmoid volvulus?
Overloaded with faeces, sinks downwards, and twists.
Who is most affected by caecal volvulus?
Younger patients.
What are some risk factors for volvulus?
- Elderly patients * Male > female * Neuropsychiatric disorders (e.g. parkinsons) * Reduced mobility * Chronic constipation * High fibre diet * Pregnancy * Adhesions
What are the clinical features of volvulus?
- Diffuse abdominal pain * Abdominal distension * Absolute constipation * Vomiting (green bilious, late presentation) * If perforation - septic shock (tachycardia, hypotension, pyrexia)
What is the ‘coffee bean’ sign?
A sign seen on abdominal x-ray indicative of volvulus.
What imaging is used to confirm a diagnosis of volvulus?
Abdominal xray followed by contrast CT scan to exclude other pathology.
What is the initial management of volvulus similar to?
Bowel obstruction.
List the initial management steps for volvulus.
- Nil by mouth * NG tube * IV fluids
What is conservative management for volvulus if no peritonitis is present?
- Endoscopic decompression with flexible sigmoidoscope * 60% risk of recurrence
What surgical management options are available for volvulus?
- Laparotomy * Hartmann’s procedure (for sigmoid volvulus) * Ileocaecal resection or right hemicolectomy (for caecal volvulus)
