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VOLVULUS
• Definition: Twist of
the bowel about an
axis.
• 15% of all intestinal
obstructions.
Volvulus
Gastric volvulus Midgut volvulus Colonic volvulus
Sigmoid Caecal
• 90%---sigmoid volvulus
• <20%---caecal
CAECAL VOLVULUS
 Etiology: congenital defect
in fixation of right colon
 Commonest cause in
pregnancy
 Early vascular impairment
 X-ray shows round gas
shadow in LUQ
 Treatment: hemicolectomy
with ileocolic anastomosis
SIGMOID VOLVULUS
 ETIOLOGY: Chronic
constipation
 PREDISPOSING
FACTORS: fig beside
 Vascular compromise
requires 1.5 times turn;
unlikely
CLINICAL FEATURES
Pain
abdomen
Abdominal
distension
obstipation
Late
vomitting
TYMPANITIC NOTE
TYRE LIKE FEEL(diagnostic)
IMAGING STUDIES
xray:
coffee bean appearance
barium swallow: bird beak
appearance
TREATMENT
 Resuscitation
 Detorsion by
sigmoidoscope, rectal tube
for decompression
 Later, elective colectomy.
(recurrence high)
 Emergency surgical
exploration: features of
peritonitis, strangulation,
gangrene, perforation
 Viable bowel: primary
anastomosis
non viable: hartmanns
procedure

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Volvulus

Editor's Notes

  1. 90%---sigmoid volvulus <20%---caecal