Volvulus

• What is volvulus?


  Torsion of the colon -> compromised blood flow and closed loop obstruction
• What % of cases are sigmoid volvulus?


  80
• What is signmoid volvulus?

  Sigmoid colon twisting -> large bowel obstruction
• Why is the caecum not at risk of twisting in most people?


  Retroperitoneal structure
• Why do some people have a higher risk of developing caecal volvulus?


  Developmental failure -> peritoneal fixation -> inc risk of caecal volvulus
• What are some risk factors for sigmoid volvulus?


  Elderly

  Chronic constipation

  Chagas disease

  Neuro conditions

  Psych conditions
• What are some risk factors for caecal volvulus?


  Adhesions

  Pregnancy
• What are some signs and symptoms of volvulus?


  Constipation

  Abdo bloating

  Abdo pain

  Nausea

  Vomiting
• How is volvulus investigated?


  Abdo film
• WHat do you expect to see in a sigmoid volvus imaging?


  Large bowel obstruction + coffee bean sign
• WHat do you expect to see in a caecal volvus imaging?


  Small bowel obstruction
• How is sigmoid volvulus managed?


  Rigid sigmoidoscopy + rectal tube insertion
• How is caecal volvulus managed?


  Operative - right hemicolectomy