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)
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