Volvulus

Question 1

What is volvulus?

Answer 1

1. Twisting of a bowel loop around its mesentery, causing obstruction and potential ischaemia.
2. Malrotation-related volvulus - MC in infants; can occur in older children.

Question 2

What is the main cause of volvulus in infants?

Answer 2

Congenital intestinal malrotation

Question 3

Another cause of volvulus - less common in older children

Answer 3

Adhesions or prior surgery

Question 4

2 RF

Answer 4

1. Infancy - first month of life
2. Hx of malrotation or congenital GI anomaly

Question 5

5 sx

Answer 5

1. Bilious vomiting (classic in neonates)
2. Abdominal distension
3. Acute, severe abdominal pain
4. Lethargy, irritability
5. Occasionally, blood-stained stools

Question 6

Ix

Answer 6

1. Abdominal XR - obstruction, ‘double bubble’ sign in neonates
2. Upper GI contrast study - GS (detects malrotation)
3. US shows the ‘whirlpool’ sign of twisted mesentery

Question 7

Mx

Answer 7

1. Stabilisation - IV fluids + electrolutes + NG decompression
2. Urgent surgery - Ladd procedure to correct malrotation and untwist bowel
3. Resection - if bowel is necrotic
4. Abx perioperatively

Question 8

3 complications

Answer 8

1. BOWEL ISCHAEMIA + NECROSIS
2. Sepsis
3. Short bowel syndrome if extensive resection is required

Question 9

Recurrence risk

Answer 9

Very rare after Ladd procedure