volvulus

1. VOLVULUS
• Definition: Twist of
the bowel about an
axis.
• 15% of all intestinal
obstructions.

2. Volvulus
Gastric volvulus Midgut volvulus Colonic volvulus
Sigmoid Caecal
• 90%---sigmoid volvulus
• <20%---caecal

3. 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

4. SIGMOID VOLVULUS
 ETIOLOGY: Chronic
constipation
 PREDISPOSING
FACTORS: fig beside
 Vascular compromise
requires 1.5 times turn;
unlikely

5. CLINICAL FEATURES
Pain
abdomen
Abdominal
distension
obstipation
Late
vomitting
TYMPANITIC NOTE
TYRE LIKE FEEL(diagnostic)

6. IMAGING STUDIES
xray:
coffee bean appearance
barium swallow: bird beak
appearance

7. 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