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Volvulus

The initial management is the same as with bowel obstruction (nil by mouth, NG tube and IV fluids). Conservative management with endoscopic decompression can be attempted in patients with sigmoid volvulus (without peritonitis). A flexible sigmoidoscope is inserted carefully, with the patient in the left lateral position, resulting in a correction of the volvulus. A flatus tube / rectal tube is left in place temporarily to help decompress the bowel and is later removed. There is a risk of recurrence (around 60%).

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 Volvulus Quick Facts

Volvulus causes 10-15% of large bowel obstructions and occurs most commonly in the elderly...

Articles of Interest

The Case Files: Sigmoid Volvulus in an Adolescent

Sigmoid volvulus, though rare in children, should be considered in any patient presenting with symptoms of bowel obstruction. Early diagnosis and decompression is vital to prevent complications such as bowel ischemia, gangrene, or perforation.

A Painful Twist

Large bowel obstruction occurs when there is rotation or torsion of the large bowel and represents approximately 25% of all intestinal obstructions. Cecal volvulus, or twisting of the cecum and ascending colon, comprises about 1 to 3% of all large bowel obstructions. It is a rare condition that is very dangerous as it can progress to tissue necrosis and possibly perforation of the bowel.

Abdominal Computed Tomography with a Twist: The ‘Whirl Sign’ for Mesenteric Volvulus

The “whirl sign” on CT imaging is a highly specific finding for intestinal volvulus (albeit poorly sensitive), and should raise suspicion for a closed loop obstruction.

Acute cecal volvulus: A diagnostic and therapeutic challenge in emergency: A case report

The volvulus of the cecum occurs on a mobile cecum following an axial twisting of the cecum around its mesentery. The diagnosis is most often delayed because of clinical signs that are nonspecific. Abdominal CT is the key examination for diagnosis. The treatment is only surgical. The diagnostic delay is responsible of the high mortality rate reported in literature.

Air Care Series: Acute Gastric Volvulus

As acute gastric volvulus can present with nonspecific findings of abdominal pain and retching, the differential diagnosis can be broad and include bleeding esophageal varices and gastric outlet obstruction.

Bowel obstructions: Twisted Bowels

Colicky abdominal pain with abrupt onset (70-92%).

Cecal Volvulus in Children

Rare doesn’t mean Never. Be vigilant, especial with at risk patients (ex, kids with neurodevelopment delays and/or chronic constipation).

Cecal volvulus is rare but a big deal

I’ve only seen this a few times, but each case presented with a very ill child with an acute obstruction.

Clinical guideline for management of sigmoid volvulus

Rigid or flexible endoscopy should be performed to assess sigmoid colon viability and to allow initial detorsion and decompression of the colon.

Emergency Strategy - How to treat volvulus

CT scan is useful in identifying the extent obstruction in case of sigmoid volvulus. In cecal volvulus whirl sign may present. Ultrasound may also reveal whirlpool signs of volvulus where the vessel twirled around the mesentery base. Ultrasound may reveal abnormal position of superior mesenteric vein.

Gastric volvulus: A truly rare, but life-threatening cause of upper abdominal pain

Given the 30-50% mortality rate if left untreated, a gastric volvulus is a rare surgical emergency with a potentially high morbidity and mortality. It is generally not considered among the top potential diagnoses in a patient presenting to the ED with abdominal pain and retching. Keeping this diagnosis in mind may help to avoid the many potential adverse outcomes associated with this uncommon disease.

Gastric Volvulus: ED Presentation, Evaluation, and Management

Gastric volvulus is a relatively uncommon diagnosis, with about 80-90% of cases occurring in adults and 10-20% in children, with an equal incidence among males and females.

Midgut Volvulus: The Whirlpool and Corkscrew Signs

The "corkscrew sign" refers to the twisted configuration of the proximal small bowel loops seen on upper gastrointestinal (UGI) in the setting of malrotation with midgut volvulus. The "whirlpool sign" is it sonographic counterpart and consists of a swirling pattern of flow on color Doppler ultrasound images created when the superior mesenteric vein (SMV) and the mesentery wrap around the superior mesenteric artery (SMA). Midgut volvulus is a life-threatening condition that usually occurs in neonates and young infants.

Sigmoid Volvulus in Children

It is uncommon in children, but life-threatening...

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.

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TeachMeSurgery

Particularly noteworthy in cases of volvulus, compared to other causes of bowel obstruction, is the rapidity of onset (over a few hours) and degree of abdominal distension.