Volvulus

Question 1

Define Volvulus?

Answer 1

Rotation of a loop of small bowel around the axis of its mesentry that results in bowel obstruction and potentially ischaemia

Question 2

What are the areas usually affected in Volvulus?

Answer 2

Sigmoid Colon - 65%
Caecum - 30%
Midgut

Question 3

What is Volvulus Neonatorum?

Answer 3

Occurs in neonates and typically affects the midgut

Question 4

What is the aetiology of Volvulus?

Answer 4

Anatomical factors e.g. long mesentery

Question 5

What are the risk factors in Adults for Volvulus?

Answer 5

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

Question 6

What are the risk factors in neonates for Volvulus?

Answer 6

Malrotation

Question 7

What are the presenting symptoms of Volvulus?

Answer 7

Severe colicky abdominal pain and swelling
Absolute constipation
Vomiting
There may be a history of transient attacks in which spontaneous reduction of the volvulus

Question 8

At what age does Neonatal Volvulus present?

Answer 8

Around 3 months

Question 9

What are the signs of Volvulus on physical examination?

Answer 9

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

Question 10

What investigations would you do for Volvulus?

Answer 10

AXR
Erect CXR
Water-soluble contrast enema
CT scan

Question 11

When do we do an Erect CXR for Volvulus?

Answer 11

If perforation is suspected

Question 12

Why do we do a Water-soluble contrast enema for Volvulus?

Answer 12

Shows site of obstruction