Volvulus

Question 1

What is volvulus?

Answer 1

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

Question 2

Which areas are commonly affected in volvulus?

Answer 2

Sigmoid colon: 65%
Caecum: 30% - most proximal part of large bowel hence will not really cause LBO but may cause SBO
Volvulus Neonatorum: occurs in neonates, normally midgut

Question 3

List 6 risk factors for volvulus in adults

Answer 3

Long sigmoid colon 
Long mesentery  
Mobile caecum (failure of caeucum) 
Chronic constipation  
Adhesions 
Chagas disease (parasite)/ other Parasitic infections

Question 4

What causes volvulus in neonates?

Answer 4

Malrotation: incomplete rotation of the midgut causing a failure in the attachment of the caecum to the posterior abdominal wall

Question 5

List 4 symptoms of volvulus

Answer 5

Severe colicky abdominal pain + swelling
Absolute constipation
Vomiting
Possible hx of transient attacks in which spontaneous reduction of the volvulus has occurred

Question 6

List 5 signs of volvulus

Answer 6

Abdominal distension + tenderness 
Tinkling bowel sounds (intestinal obstruction) 
Fever  
Tachycardia  
Signs of dehydration

Question 7

At what age do neonates with volvulus often present?

Answer 7

3 months

Question 8

What is seen on abdominal x-ray in sigmoid volvulus?

Answer 8

Coffee bean sign

Question 9

What is seen on abdominal x-ray in caecal volvulus?

Answer 9

Embryo sign

Question 10

What investigations may be performed for suspected volvulus?

Answer 10

AXR
Erect CXR: if perforation is suspected
Water-soluble contrast enema: visualise obstruction
CT Scan