Volvulus

Sigmoid Volvulus

• Counterclockwise twisting
• The sigmoid colon becomes overloaded with faeces, causing it to sink downwards causing a twist or torsion

Caecal Volvulus

• Clockwise twisting (Caecal – Clockwise)

Risk Factors

• Psychiatric disorders

• Neurological disorders

• Nursing home residents

• Chronic constipation

• Pelvic masses (including pregnancy)

• Adhesions

Complications

• Obstruction
• Ischaemia
• Perforation

Diagnosis

• Presents as intestinal obstruction
• Abdominal xray – coffee bean sign (dilated, twisted sigmoid colon that looks like a giant coffee bean)
• CT scan to confirm diagnosis and identify other pathology

Treatment

• Endoscopic decompression (for sigmoid volvulus with no peritonitis only)
• Laparotomy
  • Hartmann’s procedure (sigmoid)
  • right hemicolectomy (caecal)