Volvulus

Question 1

What is volvulus?

Answer 1

A condition where the bowel twists around itself and the mesentery it is attached to.

Question 2

What is the function of the mesentery?

Answer 2

Connects bowel with posterior abdominal wall and provides blood supply to bowel via mesenteric arteries.

Question 3

What occurs when the bowel twists in volvulus?

Answer 3

Leads to a closed-loop bowel obstruction.

Question 4

What happens if blood vessels are involved in volvulus?

Answer 4

Cut off blood supply to bowel, leading to bowel ischaemia, necrosis, and perforation.

Question 5

What are the two main types of volvulus?

Answer 5

• Sigmoid volvulus * Caecal volvulus

Question 6

What is the most common cause of sigmoid volvulus?

Answer 6

• Chronic constipation with lengthening of mesentery

Question 7

What happens to the sigmoid colon in sigmoid volvulus?

Answer 7

Overloaded with faeces, sinks downwards, and twists.

Question 8

Who is most affected by caecal volvulus?

Answer 8

Younger patients.

Question 9

What are some risk factors for volvulus?

Answer 9

• Elderly patients * Male > female * Neuropsychiatric disorders (e.g. parkinsons) * Reduced mobility * Chronic constipation * High fibre diet * Pregnancy * Adhesions

Question 10

What are the clinical features of volvulus?

Answer 10

• Diffuse abdominal pain * Abdominal distension * Absolute constipation * Vomiting (green bilious, late presentation) * If perforation - septic shock (tachycardia, hypotension, pyrexia)

Question 11

What is the ‘coffee bean’ sign?

Answer 11

A sign seen on abdominal x-ray indicative of volvulus.

Question 12

What imaging is used to confirm a diagnosis of volvulus?

Answer 12

Abdominal xray followed by contrast CT scan to exclude other pathology.

Question 13

What is the initial management of volvulus similar to?

Answer 13

Bowel obstruction.

Question 14

List the initial management steps for volvulus.

Answer 14

• Nil by mouth * NG tube * IV fluids

Question 15

What is conservative management for volvulus if no peritonitis is present?

Answer 15

• Endoscopic decompression with flexible sigmoidoscope * 60% risk of recurrence

Question 16

What surgical management options are available for volvulus?

Answer 16

• Laparotomy * Hartmann’s procedure (for sigmoid volvulus) * Ileocaecal resection or right hemicolectomy (for caecal volvulus)