1. Volvulus is a condition where a loop of intestine twists around its mesentery, obstructing the bowel. This can occur in the sigmoid colon, cecum, stomach, or small intestine. 2. Patients present with symptoms of intestinal obstruction like abdominal pain, distension, and constipation. Risk factors include old age, constipation, Hirschsprung's disease, pregnancy, and abdominal adhesions. 3. Diagnosis involves abdominal x-rays, CT scans, and barium enemas to identify the site of obstruction. Treatment depends on the severity but may include decompression via sigmoidoscopy or surgery to correct ischemia, perforation, or recurrent cases. Comp

1. VOLVULUS
JLENGWE jr3

2. Introduction
• Obstruction caused by a loop in the intestines that twists and surrounds
messentery, attaches intestine to back wall of the abdomen
• volvulus is simply mean, intestines twist around its mesentery
• compound volvulus a.k.a ileosigmoid knotting:- twisting of the ileum and
sigmoid and viceversa. It is an intraoperative finding (difficult to see on x-ray).
it sometimes centrally located like that of small intestine volvulus

4. TYPES
1. Sigmoid volvulus- most common
2. Ceaecal volvulus- 2nd most common
3. Gastric volvulus
4. Midgut (small intestine)
• other way of classifying includes: Acute, Sub-acute and Compound

5. Risk factors
• Old age and middle age
• Constipation
• Hirsprungs disease (increases the risk)
• Pregnancy(fetus can cause displacement and twisting of the colon)
• Abdominal adhesion(the scar tissue creates attachment between two
parts of abdomen where the colon can twist)

6. History of presenting illness
• patient presents with features of intestinal obstruction
• colick abdominal pain
• abdominal distension
• absolute constipation
• vomiting (usually late sign due to sigmoid distally located)
• dehydration
• fever

7. Physical examination
• Distended abdomen
• Abdomen is often very tympanic to percussion
• If perforate or ischaemic: features of peritonism

8. Clinical investigation
LABORATORY
• Full blood count and differentials
• electrolytes and urea, creatinine
• liver function test
• erythrocyte sedementation rate(ESR)

9. IMAGING (diagnostics modalities)
• Abdominal x-ray (coffee bean/sigma sign, fridmandell’s sign,omega
sign)
- Erect x-ray - gases
- Supine x-ray - gas fluid levels
• Barium enema

11. • Ct scan (abdomen -pelvis with contrast)
- much more sensitive and specific for bowel obstruction
- identifies the site and cause
- classically demonstrate a very dilated sigmoid colon with a ‘whirl
sign’, from the twisting mesentery around its base

12. Differential diagnosis
• Severe constipation
• Pseudo-obstructions
• Severe sigmoid diverticular disease

13. Treatment
• Sigmoidoscopy and insertion of the flatus tube (to decompress and
devolvulate the sigmoid volvulus)
• Colonoscopy (to decompress and devolvulate the midgut)
• Surgery (indication for surgery- laparatomy for a hartmann’s procedure)
- colonic ischaemia or perforation
- repeated failed attempts of decompression
- necrotic bowel noted at endoscopy

14. Complications
• strangulation
• gangrene
• perforation
• hemorrhage
• dehydration
• shock
• electrolytes imbalances
• recurrence in cases where surgery was not done

15. JLENGWE jr3
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