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Volvulus

In this condition, the bowel twists around on itself and the mesentery attached to it, causing a closed-loop bowel obstruction. The 2 main types of volvulus are:

  • Sigmoid – More common overall and tends to affect older patients – Key cause is chronic constipation, and is associated with a high-fibre diet and excessive laxative-use

  • Caecal – Less common and tends to affect younger patients


In these situations, there's a high risk of ischaemia, necrosis, and perforation as the mesentery contains the gut’s blood supply.


Presentation

  • Abdominal distension

  • Absolute constipation

  • Diffuse abdominal pain

  • Bilious vomiting


Investigations

  • XR – Coffee bean sign

  • Contrast CT – Confirms diagnosis and shows other pathologies

“Plain X ray of a cecal volvulus” © James Heilman, MD CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Management

  • Same as with every bowel obstruction – NBM, NGT, IVF

  • Endoscopic decompression – Carries a risk of reoccurrence

  • Ileocaecal resection or Right hemicolectomy for caecal volvulus




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