Volvulus

Question 1

What is volvulus

Answer 1

Volvulus = when a loop of intestine twists around itself on its mesentery, resulting in bowel obstruction
• Main types: sigmoid and caecal

Question 2

What is the aetiology of volvulus?

Answer 2

Volvulus can develop in any portion of the bowel
o Most common in large bowel in sigmoid colon due to the mesenteric anatomy - High fiber diet in developing countries leads to overloading of the sigmoid, Chronic constipation

The presence of a long mesentery with a narrow base of fixation to the retroperitoneum and elongated bowel predisposes the formation of volvulus

Question 3

What are the risk factors of volvulus?

Answer 3

• Birth defect – intestinal malrotation
• Enlarged colon
• Neuropsychiatric disroders
• Old age
• Resident in nursing home
• Pregnancy
• Adhesions
• Long term constipation
• High fiber intake

Question 4

What is the epidemiology of volvulus?

Answer 4

Malrotation occurs in 1 in 500 live births
o 80% diagnosed within first month

40-70% are sigmoid, 10-50% are caecal

Sigmoid volvulus is a relatively uncommon cause of obstruction (<10%)
o Very common in other parts of the world
o Usually occurs in older adults

Caecal volvulus is slightly more prevalent in younger females

Question 5

What are the symptoms of volvulus?

Answer 5

Varies depending on location

Obstruction
o	Abdominal pain
o	Bloating
o	Vomiting
o	Constipation
o	Bloody stool

Ischaemia
o Severe abdominal pain

Question 6

What are the signs of volvulus?

Answer 6

Varies depending on location

Obstruction
o Distention

Ischaemia
o Fever
o Significant tenderness
o Lactic acidosis

Question 7

What are the investigations for volvulus?

Answer 7

Bloods
o FBC - Elevated WBC and left shift suggest ischaemia/infection/sepsis

AXR
o Massive dilation
o Bent inner/coffee bean tube sign

Barium enema – Upper GI contrast series
o ‘Bird’s beak’ termination at the point of sigmoid volvulus