Volvulus

Question 1

What is a volvulus?

Answer 1

• twsiting of loop of intestine around mesenteric attachement - closed loop bowel obstruction

Question 2

What are the Cx of volvulus

Answer 2

• Bowel ischaemia
• Bowel perforation

Question 3

Which part of the bowel does volvulus commonly occur?

Answer 3

• Sigmoid colon (most common)
• caecum (2nd common)

Question 4

What is the Px of volvulus?

Answer 4

1. Age, mesentery gets longer
2. Segment of bowel more prone to twisting on its mesenteric base

Question 5

What are the RF for volvulus?

Answer 5

• Age
• Neuropsychiatric disorders
• Chronic constipation
• Male
• Previous abdominal operation

Question 6

How would volvulus present?

Answer 6

*present similar to bowel obstruction

• colicky pain - occurs after few hours
• abdominal distention
• Constipation
• vomiting (late sign in sigmoid volvulus
• Tympanic precussion

Question 8

What are the differentials for volvulus?

Answer 8

• bowel obstruction
• pseudo-obstruction
• sigmoid divertcular disease
• severe constipation

Question 9

What Ix would you order for volvulus?

Answer 9

• bloods
  
  • Routine
  • electrolyte - Ca
  • Thyroid Function Test
• CT c contrast abdo-pelvis - initial Ix
  
  • much more sensitive, specific and identifies location and cause
  • whirl sign
• AXR
  
  • coffee-bean sign

Question 10

What are the conservative mx of volvulus?

Answer 10

• sigmoidoscope decompression
• insertion of flatus tube
  
  • left for up to 24 hrs
  • after decompression

Question 11

What is the surgical option for Volvulus

Answer 11

• Hartmann’s procedure
• Sigmoidectomy
  
  • if pt is healthy and has recurrent volvulus

Question 12

What is the indication for surgery for volvulus?

Answer 12

• colonic ischaemia
• colonic perforation
• repeated failed decompressions
• necrotic bowel on endoscopy

Question 13

What are the differentiating features between sigmoid and caecal volvulus on AXR?

Answer 13

Sigmoid

• arises in the pelvis (left lower quadrant)
• extends towards the right upper quadrant
• ahaustral in appearance
• sigmoid volvulus causes obstruction of the large bowel, therefore the ascending, transverse and descending colon may be dilated

Caecum

• arises in the right lower quadrant
• extends towards the epigastrium or left upper quadrant
• colonic haustral pattern is maintained
• distal colon is usually collapsed and the small bowel is distended

Question 15

What is the age onset for caecal volvulus?

Answer 15

• bimodal
• 10-29 / 60-79

Question 16

What causes caecal volvulus in younger age?

Answer 16

• intestinal malformation
• excessive exercise

Question 17

What causes caecal volvulus in older age?

Answer 17

• chronic constipation
• distal obstruction
• dementia