Volvulus

A torsion or twisting of a loop of intestine around its mesenteric axis, potentially leading to bowel obstruction and ischaemia.

• Often due to anatomical abnormalities, including a redundant or long mesentery or past surgeries.
• Commonly affected 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.

• Signs of bowel obstruction or perforation:
  • Severe abdominal pain and distension.
  • Nausea and vomiting.
  • Absence of flatus.
• Constipation or obstipation (severe constipation with no passage of gas or stools).
• Peritonitis if the bowel becomes necrotic and ruptures.

• 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.

• Immediate resuscitation with intravenous fluids.
• Decompression using a sigmoidoscope or colonoscope, especially for sigmoid volvulus. This can be both diagnostic and therapeutic.
• Emergency 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.

• Bowel ischaemia and necrosis.
• Perforation leading to peritonitis.
• Recurrence, especially if not surgically managed.

• Elective surgery post-endoscopic decompression to prevent recurrence in those at high risk.
• Management of underlying risk factors, (e.g., addressing chronic constipation).

• Volvulus commonly occurs in the sigmoid colon (sigmoid volvulus) and the caecum (caecal volvulus).
• Understanding volvulus is crucial as early diagnosis and intervention can prevent severe complications like bowel necrosis.
• Patients present with severe abdominal pain, abdominal distension and constipation.
• Diagnosis is determined by imaging (abdominal X-ray, CT), showing characteristic signs of volvulus dependent on location.
• Management includes immediate resuscitation and decompression through flexible sigmoidoscopy or colonoscopy.