Volvulus

Contributed by: Amad A. Qadeer, Baylor College of Medicine, 1 Baylor Plaza, Houston, Tx 77030

Overview

• Volvulus is torsion of a segment of bowel around its mesentery and depending on the extent of rotation, can lead to obstruction or infarction of the bowel. Volvulus can occur anywhere along the gastrointestinal tract but most commonly occurs in the sigmoid or cecum.

Risk Factors and Pathogenesis

• Sigmoid volvulus tends to occur in the elderly and is predisposed in those with a long redundant sigmoid with narrow mesenteric base. Cecal volvulus can occur in the context of a hypermobile cecum.
• As the bowel rotates intestinal obstruction occurs first followed by vascular compromise and potentially bowel infarction.

Clinical Manifestations

• The clinical manifestations of volvulus track those of bowel obstruction and potentially infarction. Onset of symptoms can be slow and includes abdominal pain, nausea, vomiting, distention, and constipation. If bowel infarction does occur, perforation of the GI tract may ensue. Abdominal CT is the preferred imaging modality for diagnosis

Management

• Mechanical decompression via flexible sigmoidoscopy is often the initial choice of treatment and if not successful is typically followed by surgery.

Further reading

• Halabi, Wissam J., et al. "Colonic volvulus in the United States: trends, outcomes, and predictors of mortality." Annals of surgery 259.2 (2014): 293-301.
• Hasbahceci, Mustafa, Fatih Basak, and Orhan Alimoglu. "Cecal volvulus."Indian Journal of Surgery 74.6 (2012): 476-479.
• Oren, Durkaya, et al. "An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases."Diseases of the colon & rectum 50.4 (2007): 489-497.
• Shepherd, J. J. "The epidemiology and clinical presentation of sigmoid volvulus." British Journal of Surgery 56.5 (1969): 353-359.

To cite this article

Qadeer AA, “Volvulus" in Pathway Medicine: An Introduction to Clinical Medicine, PathwayMedicine.org (2015).