Volvulus

Question 1

Define Volvulus

Answer 1

Twisting of a stricture around itself to cause intestinal obstruction

Question 2

Aetiology of Volvulus

Answer 2

Common sites: sigmoid and caecum (rarely stomach)

Sigmoid volvulus: bowel twists on its mesentery -> severe rapid, strangulated obstruction

Question 3

Risk factors for Volvulus

Answer 3

Age
Co-morbidities
Previous abdominal surgery
Abdominal/inguinal hernia

Question 4

Symptoms of volvulus

Answer 4

LLQ pain (Steady, colicky, may be periumbilical/hypogastric)
Nausea and vomiting 
Haematemesis 
Diarrhoea or constipation
Haematochezia

Question 5

Signs of Volvulus on examination

Answer 5

Diffuse abdominal distension and tenderness
faint or no bowel sounds
Fever
Occult or frank blood on DR

Peritonitis: rigid abdomen, guarding, rebound tenderness

Question 6

Investigations for volvulus

Answer 6

AXR: “coffee-bean” (sigmoid) or “embryo” (caecal) sign | Partial/complete obstruction | dilated bowel loops | air-fluid levels

FBC: Elevated WBC

Barium or water soluble contrast enema: Bird beak’s sign at the stricture of the volvulus (if AXR not clear)
CT abdomen: bowel obstruction + whirl pattern of mesentery (not usually necessary)