VOLVULUS FEATURES It is the twist (rotation) in the axis of the loop of the bowel either clockwise or anticlockwise.

1. en love da Homoeopathy
VOLVULUS

2. VOLVULUS

3. VOLVULUS
FEATURES
• It is the twist (rotation) in
the axis of the loop of the
bowel either clockwise or
anticlockwise.
• 15%of large bowel
obstruction is due to
volvulus.
• Sigmoid colonis the
commonest site (anti
clock wise)

5. • Caecal volvulus Caecumis
the secondcommonsite
(clockwise)
• It is common in females,
present as intestinal
obstruction.
• Caecal bascule is the
presence of constricting
band acrossthe ascending
colon(Bascule—
French—see-sawand
balance).
• Caecumwill be markedly
distendedand found in the
centre of the abdomen.
• It is due to lack of fixation
of the caecum—mobile
caecum.
• malrotation.
• Caecal volvulus is the
commonest cause of large
bowel obstructionin
pregnancy.

6. COMMON
• It is common becauseof high
fibre diet.
• commoncauseof large bowel
obstruction in Peru and
Boliviadue to high altitude.
• More common in males and
old age.
• It is common in patients with
chronic constipation with
laxative abuse.
PREDISPOSINGFACTORS
• Ogilvie’s syndrome ™
• Mentally-retarded
individuals™
• Chaga’s disease™
• Hypothyroidism™
• Anticholinergicdrugs ™
• Multiplesclerosis ™
• Scleroderma ™
• Parkinson’s disease
• Adhesions ™
Peridiverticulitis ™
• mesocolon™
• Narrowattachment of
sigmoidmesocolon

7. PATHOLOGY
Alwaysrotation is
anticlockwise.
↓
It requires one and half turn
of rotationto causevascular
obstruction and gangrene
↓
whicheventuallyleads into
perforation
↓
either at the root or at the
summitof the sigmoid loop.
↓
Enormous distension of the
colon occurs.
↓
Some times ileumcomes to the
root of thesigmoidvolvulus and
encircles it .

8. TYPES
1. Acute.
2. Recurrent.
CLINICALFEATURES
• Pain in the
abdomen—initially
left sided
• Absolute
constipation
(obstipation—no
faeces, no flatus).
• Enormous distension
of abdomen, starting
fromleft iliac fossa
extending to the
whole of the
abdomen(Tympanic
abdomen).

9. • Late vomiting and
eventually dehydration.
• Features of peritonitis.
• Hiccoughand retching
can occur.
• Tyre likefeel of the
abdomenis diagnostic.
INVESTIGATION
1. PlainX-ray
Ω sign(omega sign)—
single, grossly distended
loop of colonarising out
of thepelvis and
extending towards the
diaphragm. Coffee-bean
signor Bent-inner tube
sign.

10. 2. Contrast enema:
(dilutebarium/water
soluble contrast media
is used)
Birds beak sign(ace of
spades appearance)—
Upper end of barium
column tapers into the
spirallytwisteddistal
sigmoidcolon.
3.CTscan (for difficult cases):
Shows characteristicwhirl
pattern.
4. Blood—Haematocrit,
5.Renal function tests
6.Serumelectrolytes
TREATMENT
• IV fluids.
• Catheterisation.
• Antibiotics

11. DIFFERENTIAL DIAGNOSIS
• Ogilvies’s syndrome
• It is acutecolonicpseudo
obstruction.
• It is due to malfunctioning
sacral parasympathetic
nerves.
• Splenic flexure is the junction
of collapsed and dilated large
bowel.
• Descending colonis atonic
causing acute functional
obstruction.
• It may be due to trauma
• retroperitoneal irritation
• antidepressants
• Uraemia
• Diabetes
• Myxoedema
• Hypokalaemia etc.
• Prokineticdrugs
• colonoscopic
decompression
• Faecal impaction. ™
• Carcinoma recto sigmoid
region. ™
• Idiopathicmegacolon.

12. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

13. A
Special Thanks
To A Very
Special Doctor