Volvulus
Summary
VOLVULUS
PATHOLOGY & CAUSES
- Intestinal twisting/looping
TYPES
- Classified by location
Sigmoid volvulus (most common)
Usually middle-aged/elderly individuals
Causes include pregnancy, chronic constipation (e.g. Hirschsprung’s disease), intestinal adhesions
Cecal volvulus
- Causes include impaired abdominal mesentery development, pregnancy, chronic constipation
Usually infants/young children
Caused by anomalous intestinal development (e.g. intestinal malrotation)
COMPLICATIONS
Mesenteric artery compression → intestinal wall ischemia, infarction
Intestinal wall perforation, infection (e.g. diffuse peritonitis)
SIGNS & SYMPTOMS
- Abdominal tenderness, pain, distension, bilious vomiting, constipation, fever, auscultation (abnormal bowel sounds, often decreased), percussion (tympany), hematochezia (may indicate bowel ischemia, necrosis)
DIAGNOSIS
DIAGNOSTIC IMAGING
X-ray
Asses volvulus shape
- Bent inner tube sign (“coffee bean” sign)
Barium enema
May show “bird’s beak” shape (point of twisted bowel)
Perforation suspected → barium contrast contraindicated
CT scan
- Twisted mesentery (“whirlpool” sign)
TREATMENT
SURGERY
- In case of midgut volvulus/ischemia/necrosis; surgical resection if necessary
OTHER INTERVENTIONS
IV fluid replacement
Sigmoid volvulus: sigmoidoscopy
Cecal volvulus: colonoscopy
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw Hill Professional (2019)
- "Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process" Revista Española de Enfermedades Digestivas (2004)
- "Management of Colonic Volvulus" Clinics in Colon and Rectal Surgery (2012)