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Twists and Turns: A Practical Approach to Volvulus and Intussusception

The most common location of the volvulus is the sigmoid colon (60% of cases) followed by “cecal” volvulus or bascule (20–40%). It should be understood that “cecal volvulus” is something of a misnomer, as the torsion most commonly occurs in the ascending colon, superior to the ileocecal valve. A true “bascule” involves a folding of the cecum and is much less common. Although less common in the United States, volvulus remains the third leading cause of large bowel obstruction in adults worldwide. This condition remains more prominent in the “volvulus belt” – a region extending along Africa, the Middle East, India and Russia.

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Articles of Interest

Cecal Volvulus: A Rare Cause of Intestinal Obstruction

Cecal volvulus is a torsion, usually of 360°, of a segment of the colon on its mesenteric axis, which causes strangulation – hence, an occlusion of the two ends of the volvulated segment – compromising its blood irrigation, which causes an obstruction in a closed loop...

CT of Cecal Volvulus Unraveling the Image

On axial CT images, cecal volvulus is suggested by the extreme dilatation of the cecum. When seen on conventional radiographs or tomograms, the cecal volvulus is seen as a rounded focal collection of air-distended bowel with haustral creases in the left upper quadrant that resembles a coffee bean.

Entrapment is an essential feature of sigmoid volvulus

The concept of entrapment is not entirely new, but has not been part of the common explanation of the mechanism of sigmoid volvulus, and it gives a set of predictions which are supported in the available literature...

Malrotation of the Bowel

Patients with malrotation can present in infancy or in adulthood; however, 30% present in the first month of life and 75% in the first 5 years of life. Patients can present with acute abdominal pain and bilious emesis, with an acute volvulus, with typical reflux symptoms, or with chronic abdominal pain. In some patients, malrotation is found incidentally as part of an evaluation for another problem.

Midgut Volvulus: A Rare Gastrointestinal Disease in Adults

Midgut volvulus is a rare and potentially deadly cause of abdominal pain in adults.

Podcast 707: Sigmoid Volvulus

More common in elderly patients with chronic constipation...

Sigmoid Volvulus: A Common Cause of Bowel Obstruction

Volvulus, a condition in which the intestine twists upon itself and its mesentery and causes obstruction, involves the colon or small bowel. Small-bowel volvulus is more likely in children, whereas colonic volvulus (CV) occurs more often in adults.

Sigmoid volvulus: Coffee bean sign, whirl sign

Sigmoid volvulus is the third most common cause of bowel obstruction after cancer and diverticulitis. Risk factors include chronic constipation, diabetes mellitus, neurologic disorders, and previous abdominal surgery. The classic clinical presentation is a triad of abdominal pain, distention, and constipation.

The vomiting infant: When should intestinal volvulus be suspected?

Vomiting is a frequent reason for visits to the emergency department. When infants aged less than 1 year present with vomiting, the differential diagnosis should include intestinal volvulus despite its infrequent occurrence, as early diagnosis and treatment are crucial to achieve a favourable outcome.

Volvulus

Sigmoid volvulus is more common and tends to affect older patients. The twist affects the sigmoid colon. A key cause is chronic constipation and lengthening of the mesentery attached to the sigmoid colon. The sigmoid colon becomes overloaded with faeces, causing it to sink downwards causing a twist. It is also associated with a high fibre diet and the excessive use of laxatives.

Volvulus (Twisting of the Colon)

Volvulus can be caused by malrotation or by other medical conditions such as an enlarged colon, Hirschsprung disease, a disease of the large intestine that causes severe constipation or intestinal obstruction, abdominal adhesions, or bands of scar tissue that form as part of the healing process following abdominal injury, infection, or surgery.

Volvulus and Midgut Malrotations

A volvulus is a complete twisting of a loop of intestine around its mesenteric attachment site. This can occur at various locations of the gastrointestinal (GI) tract, including the stomach, small intestine, caecum, transverse colon and sigmoid colon. Midgut malrotation refers to twisting of the entire midgut about the axis of the superior mesenteric artery

Resources

HealthJade

The term volvulus is Latin for “volvere,” which means “to roll.”

JETem

Volvulus is an emergent condition that occurs when the colon twists on its mesenteric axis greater than 180 degrees, producing obstruction of intestinal lumen and mesenteric vessels. The incidence of volvulus is rare in the United States, with the most common locations of volvulus being the sigmoid colon and cecum with 60%-70% and 20%-30% of cases reported, respectively.