Volvulus Flashcards
What is a volvulus?
Twisting of a loop of intestine around its mesenteric attachment resulting in a closed loop bowel obstruction
What happens to the affected bowel in a volvulus?
becomes ischaemic due to compromised blood supply causing necrosis and perforation
Where do volvuli usually occur?
Sigmoid colon but can also occur in the stomach, caecum, small and transverse colon
Why is the sigmoid colon the most likely to get a volvulus?
Had a long mesentery so is prone to twisting on its mesenteric base to form a volvulus
What are the risk facts for a volvulus?
increasing age, neuropsychiatric disorders, resident in a nursing home, chronic constipation or laxative use, male gender, previous abdominal operations
What are the clinical features of a volvulus?
clinical features of bowel obstruction such as colicky pain, abdominal distention which is large, constipation, r
What will be present on examination of a volvulus?
tympanic to percussion, perforation, peritonitis if ischaemia or perforation
What are the differential diagnosis of a volvulus?
bowel obstruction, severe constipation, pseudo-obstruction and severe sigmoid diverticular disease
What are the blood tests that should be taken for suspected volvulus?
routine bloods and electrolytes, Ca and TFTs to exclude psuedo-obstruction
What imaging should be done for suspected volvulus?
CT scan of the abdomen and pelvis with contrast as can identify the site and cause- whirl sign as the twist mesentery around the base
How would a volvulus appear on a AXR?
coffee bean sign from left iliac fossa
What is the management for a volvulus?
decompression by a signmoidiscope and insertion of a flatus tube, if this does not work then flexible sigmoidoscope and formal decompression is needed,
When is surgical management required for a volvulus?
colonic ischaemia or perforation, repeated failed decompression, necrotic bowel
What surgery is usually preformed for a volvulus?
Hartmanns procedure or if elective then sigmoidectomy with primary anastomosis
What are the complications of a volvulus?
bowel ischaemia and perforation, risk of recurrence and complications from a stoma if placed,
