Volvulus

Question 1

Define

Answer 1

• Rotation of a loop of small bowel around the axis of its mesentery that results in bowel obstruction and potential ischaemia.

Question 2

What areas are usually affected?

Answer 2

• The areas usually affected:
o Sigmoid colon - 65%
o Caecum - 30%
o Volvulus Neonatorum - occurs in neonates and typically affects the midgut

Question 3

What are the risk factors?

Answer 3

o	Adults
•	Long sigmoid colon
•	Long mesentery 
•	Mobile caecum 
•	Chronic constipation 
•	Adhesions
•	Chagas disease
•	Parasitic infections 
o	Neonatal
•	Malrotation

Question 4

What are the presenting symptoms?

Answer 4

• Severe colicky abdominal pain and swelling
• Absolute constipation
• Vomiting
• There may be a history of transient attacks in which spontaneous reduction of the volvulus has occurred
• Neonatal volvulus presents around 3 months

Question 5

What are the signs?

Answer 5

• Signs of bowel obstruction with abdominal distension and tenderness
• Absent or tinkling bowel sounds
• Fever
• Tachycardia
• Signs of dehydration

Question 6

What are the appropriate investigations?

Answer 6

AXR
•	Erect CXR - if perforation is suspected 
•	Water-soluble contrast enema
o	Shows site of obstruction 
•	CT Scan