Diagnosis

Volvulus

Rotation of a segment of intestine about its mesenteric axis causing gastrointestinal obstruction.

Etiology

Anatomical distribution [47k][9ds]

  1. Sigmoid colon (most common)

  2. Cecum

  3. Midgut (intestinal malrotation in children)

  4. Gastric

  5. Transverse colon

  6. Splenic flexure

Pathophysiology [fqm]

  1. Hypermobile intraperitoneal bowel segments (distal duodenum, jejunum, ileum, cecum, colon transversum and sigmoideum) are prone to rotation

  2. Chronic constipation and a high-fiber diet --> dilated sigmoid colon --> susceptible to torsion

  3. The mesentery may become so tightly twisted that blood flow to part of the intestine is cut off, resulting in ischemic bowel

Risk factors [fqm]

Complication [fqm]

Epidemiology

Incidence per 100.000 [umk][a5g][47k][9ds]

Epidemiology chart for Incidence

Symptoms & findings

Symptoms

Absent feces, Absent flatus, Bloating, Fever, Hematochezia, Hyperactive bowel sounds, Hypoactive bowel sounds, Ileus, Nausea, Obstipation, Vomiting

Clinical findings

Absent distal rectal air, Acidosis, Air-fluid level, Elevated Lactate, Gastrointestinal dilatation

Anamneses

None listed.

Localized findings

Pain
Radiates
Abdomen
Onset
Subacute (hours)Gradual (days)
Pattern
Intermittent
Quality
Cramping
Severity
Moderate (4-7)Severe (8-10)
Swelling
Radiates
Abdomen
Onset
Gradual (days)
Pattern
Constant

Approach

Treatment

  1. Fluid resucitation [fqm]

  2. Broad-spectrum antibiotics

  3. Barium enema [rvh]

  4. Flexible sigmoidoscopy (sigmoid volvulus)

  5. Colonoscopy (colon transversum volvulus)

  6. Surgery: open or laparoscopic approach [rvh]

    • Manual detorsion

    • Cecopexy/cecostomy

    • Sigmoidopexy

    • Intestinal resection

Differential diagnoses

Acute mesenteric ischemia, Adhesion, Aortoenteric fistula, Appendicitis, Colorectal cancer, Colorectal polyp, Constipation, Diabetic gastroparesis, Diverticulitis, Drug side effects, Femoral hernia, Gastroenteritis, Gastrointestinal obstruction, Gastrointestinal perforation, Incisional hernia, Inguinal hernia, Intussusception, Ogilvie syndrome, Pseudomembranous colitis, Ruptured aortic aneurysm, Toxic megacolon, Umbillical hernia

References

[1] Ballantyne GH, Brandner MD, Beart RW Jr, Ilstrup DM. Volvulus of the colon. Incidence and mortality. Ann Surg. 1985 Jul;202(1):83-92.

[2] Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg. 2014 Feb;259(2):293-301.

[3] Le CK, Anand S, Cooper WANTZY. Volvulus. Updated 2022 Sep 12: https://www.ncbi.nlm.nih.gov/books/NBK441836/

[4] Marx J, Walls R, Hockberger R (2013). "95". Rosen's Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences.

[5] Gordon PH, Nivatvongs S (2007). Principles and Practice of Surgery for the Colon, Rectum, and Anus, Third Edition. CRC Press. p. 971.

[6] Consorti ET, Liu TH. Diagnosis and treatment of caecal volvulus. Postgrad Med J. 2005 Dec;81(962):772-6.

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