volvulus

1. VOLVULUS

2. DEFINITION
Volvulus is a twisting of the
intestine at least 180 degrees
on its mesentery, which
results in blood vessel
compression and ischemia.

3. TYPE
MIDGUT CECAL SIGMOID
VOLVULUS VOLVULUS
VOLVULUS

4. CAUSE
1. Chronic constipation (
type of Constipation ).
2. Abnormal intestinal
contents (e.g. meconium
ileus) or adhesions.
3.Congenital intestinal
malrotation.(failure

5. RISK FACTOR
Paralytic ileus
Megacolon
Hirschsprung’s disease

6. SIGN AND SYMPTOM
1.May present as abdominal
emergency
-Acute distension
-Colicky pain (spasm)
-Failure to pass flatus or stool
(constipation is prevailing
feature)
-Vomiting is late sign
2.Rapid heart rate.
3.Rapid breathing.

7. PATHOPHYSIOLOGY
• Redundant sigmoid
colon that has a narrow
mesenteric attachment
to posterior abdominal
wall allows close
approximation of 2 limbs
of sigmoid colon à

8. DIAGNOSTIC TEST
1. X-r ays — A bdom nal X-r ays m show
i ay
obst r uct i on and abnor m ai r -f l ui d l evel s
al
oi ,i
i n t he si gm d and cecum n m dgut
i
vol vul us, abdom nal X-r ays m be
i ay
nor m .
al
2. W t e bl ood cel l count — In strangulation, the
hi
count is greater than 15,000/µl, in bowel
infarction, greater than 20,000/µl.

9. CON’T…
3.B i umenem — I n cecal vol vul us,
ar a
bar i umf i l l s t he col on di st al t o t he
sect i on of cecum .
4.C put ed t om aphy scan — m show
om ogr ay
evi dence of i nt est i nal obst r uct i on.

10. X-RAY SHOWN

11. TREATMENT
1.For children with midgut
volvulus, surgery is required.
2. For adults with sigmoid
volvulus, nonsurgical treatment
includes proctoscopy to check for
infarction and reduction by
careful insertion of a flexible
sigmoidoscope to deflate the

12. TREATMENT
3.Untwisting by performing
sigmoidoscopy and placing
rectal tube, monitor for signs
of bowel ischemia for 2-3
days, if no improvement,
consult surgery for
laparotomy (sigmoid
resection and primary
anastamosis)

13. COMPLICATION
1.Dehydration
2.Ischemic bowel disease
3.Intestinal perforation
4.Peritonitis
5.Sepsis