Volvulus

Question 1

Define volvulus

Answer 1

Defined as torsion back on itself to the point it cuts of flow -usually refers to bowels (they make a knot with themselves or surrounding tissues)
most common-sigmoid volvulus, gastric volvulus
Developmental -malrotation (rotate all intestine around superior mesenteric intestine

can be chronic or acute

Question 2

Aetiology and risk factors of Volvulus

Answer 2

Malrotation-development issue, unclear
volvulus-usually long standing constipation that causes an atonic elongated colon-(megacolon).
Sigmoid volvulus-usually faeces dilated with gas loop with mesenteric to close loop-> ischemia and perforated if untreated

Risk factors: Elderly, Chronic constipation, megacolon, MEN

Question 3

Epidiemology of volvulus

Answer 3

leading cause of acute colonic obstruction in lots of countries and Europe
sigmoid is rare in children

malrotation is usually diagnosed 1st year of birth (95%), some present as adult

Question 4

Signs and Sx of Volvulus

Answer 4

Sudden onset coliquy lower abdo pain,
distended abdo
inability to pass poo/fart
Constipation
Hx of recurrent episodes of constipation followed by large outflows
exam-> distended abdo but not tender to touch
DRE-empty sigmoid canal

Vomiting happens late
delaying treatment leads to perforation -> peritonitis -> Fever/shock/sepsis

Question 5

Investigation of Volvulus

Answer 5

Abdo Xray-dilated loop (sigmoid can be so distended it reaches the xiphisternum)
tons of faeces

Abdo CT to see wall schema