Volvulus

• What is a volvulus?

  Bowel twists around itself & the mesentery that is attached to -> closed-loop bowel obstruction

  Can lead to bowel ischaemia -> necrosis & bowel perforation
• What are the main types of volvulus?

  Sigmoid

  • more common
  • affects older people

  Caecal

  • less common
  • affects younger pts
• What is a key cause of sigmoid volvulus?

  Chronic constipation

  Also associated with high fibre diet & excessive use of laxatives
• What are the RFs for volvulus?

  Older age

  Neuropsychiatric disorders (e.g. Parkinson's)

  Nursing home residents

  Chronic constipation

  Pregnancy

  Adhesions

  Previous volvulus
• What are the signs & symptoms of volvulus?

  Vomiting (esp. green bilious vomiting)

  Nausea

  Abdominal distension

  Diffuse abdo pain

  Absolute constipation & lack of flatulence

  Abdo tenderness (esp over site of volvulus)

  Absent bowel sounds
• What are the Inx for volvulus?

  Obs

  Full Hx & examination

  Bloods (FBC, U&Es, VBG)

  Abdo XR -> can show 'coffee bean' in sigmoid volvulus

  CT

  Possible colonoscopy/sigmoidoscopy
• What are the DDx of volvulus?

  Intestinal obstruction

  Appendicitis

  Gastroenteritis

  Diverticulitis
• What is the management of volvulus?

  Nil by mouth

  NG tube

  IV fluids

  Analgesia

  ? Prophylactic Abx

  Endoscopic decompression (sigmoid volvulus, if not peritonitic)

  Surgery

  • laparotomy
  • Hartmann's procedure (sigmoid volvulus)
  • Ileocaecal resection or right hemicolectomy (caecal volvulus)
• What are the possible complications of volvulus?

  Bowel ischaemia

  Bowel perforation

  Sepsis

  Abscess formation

  Recurrence