Volvulus

Question 1

Define:

Answer 1

Rotation of a loop of bowel around its axis of its mesentery leading to bowel obstruction and infarction.

Sigmoid - 65% in the elderly usually
Caecum - 30% in young adults usually to malformed mesentery
Midgut - in neonates.

Question 2

Aetiology:

Answer 2

Long sigmoid colon

long mesentery

mobile caecum

chronic constipation

adhesions

chagas disease

parasitic infections

Neonatal- malrotation

Question 3

Epidemiology:

Answer 3

Sigmoid and caecum peak at 30-70 years.

Question 4

Symptoms:

Answer 4

severe colicky pain with abdominal pain and swelling.

absolute constipation

vomiting

history of transient attacks which spontaneously reduces

neonatal presents at 3 months

Question 5

Signs:

Answer 5

signs of bowel obstruction with abdominal distension

tinkling or absent bowel sounds

abdo tenderness

fever

tachycardia

signs of dehydration

Question 6

Investigations:

Answer 6

AXR - there will be a coffee bean shaped colon ( if sigmoid), Kidney bean colon (if caecum)

erect CXR - if perforation is susoected

water soluble contrast enema - to see where the obstruction is

CT scan