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.