Volvulus

Question 1

Definition

Answer 1

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

Question 2

Areas affected

Answer 2

o Sigmoid colon - 65%
o Caecum - 30%
o Volvulus Neonatorum - occurs in neonates and typically affects the midgut

Question 3

Aetiology/Risk factors

Answer 3

• Anatomical factors (e.g. long mesentery)
• Risk Factors

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

o Neonatal
• Malrotation

Question 4

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

Signs on physical examination

Answer 5

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

Question 6

Investigations

Answer 6

• AXR
• Erect CXR - if perforation is suspected

• Water-soluble contrast enema
o Shows site of obstruction

• CT Scan