Definition
- Volvulus: A torsion or twisting of a loop of intestine around its mesenteric axis, potentially leading to bowel obstruction and ischaemia.
Etiology
- Often due to anatomical abnormalities, including a redundant or long mesentery or past surgeries.
- Commonly affects sites: sigmoid colon (sigmoid volvulus) and the caecum (caecal volvulus).
- Higher risk in older adults, particularly those residing in care facilities or with chronic constipation.
Clinical Presentation
- Severe abdominal pain and distension.
- Nausea and vomiting.
- Constipation or obstipation (severe constipation with no passage of gas or stools).
- Signs of bowel obstruction or perforation.
- Peritonitis if the bowel becomes necrotic and ruptures.
Investigations
- Abdominal X-ray: May show distinctive ‘coffee bean’ sign in sigmoid volvulus or inverted ‘U’ sign in caecal volvulus.
- Abdominal CT scan: Useful in confirming diagnosis and determining the exact location and degree of torsion.
- Flexible sigmoidoscopy or colonoscopy: Can be diagnostic and therapeutic, especially for sigmoid volvulus.
Management
- Immediate resuscitation with intravenous fluids.
- Decompression using a sigmoidoscope or colonoscope, especially for sigmoid volvulus. This can be both diagnostic and therapeutic.
- Emergent surgery for those not amenable to endoscopic decompression or if there is evidence of bowel ischaemia or perforation. Procedures may include detorsion, resection, or fixation.
Complications
- Bowel ischaemia and necrosis.
- Perforation leading to peritonitis.
- Recurrence, especially if not surgically managed.
Prevention
- Elective surgery post-endoscopic decompression to prevent recurrence in those at high risk.
- Management of underlying risk factors, e.g., addressing chronic constipation.
Understanding volvulus is crucial as early diagnosis and intervention can prevent severe complications like bowel necrosis.
