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Volvulus

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.

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