volvulus_sigmoid
Table of Contents
sigmoid volvulus
introduction
- volvulus occurs when colon twists on its mesenteric axis with a greater than 180-degree rotation, producing obstruction of intestinal lumen and mesenteric vessels
- the most common location is at the sigmoid (see also caecal volvulus, and also may less commonly occur at splenic flexure or transverse colon))
- in Western countries, the far majority occur in elderly mainly bed bound patients
aetiology
- in Western countries, the far majority occur in bed bound elderly patients with chronic constipation
- rarely, may occur in young adults with:
- adult Hirschsprung's disease
- those from developing countries with high fibre diets being thought to be a major cause
clinical features
acute fulminating volvulus
- total bowel obstruction
- sudden onset periumbilical pain with vomiting and constipation
- upper abdominal distention with tympany
- empty rectum
- visible peristalsis may be seen
- may have peritoneal signs
- gangrene and perforation occur early
subacute progressive volvulus
- partial bowel obstruction
- especially elderly
- more subtle clinical picture often leading to delayed diagnosis
- poorly characterised abdominal cramping esp. on left side
- upper abdominal distention with tympany
- empty rectum
- visible peristalsis may be seen
radiologic signs
- omega or horseshoe sign
- bird's beak sign
- Y sign
- northern exposure sign
- coffee bean sign
- bent inner tube or ace of spades sign
- left pelvic overlap or left flank overlap sign
- liver overlap sign
- the whirl sign
- empty left iliac fossa sign
Coffee bean sign courtesy of ncbi
ED Management
- discuss with surg. registrar ASAP
- if evidence of bowel ischaemia (eg. fever, tachycardia, peritonism, or air in bowel wall on plain CT abdo), then needs iv antibiotics and urgent surgery
- if no evidence bowel ischaemia, usually needs urgent rectal tube to decompress and this will usually resolve the volvulus
volvulus_sigmoid.txt · Last modified: 2016/07/23 23:01 by 127.0.0.1