(Clinical Imaging)

Overview

• Twisting of a loop of bowel on its mesentery → one of the most common causes of intestinal obstruction
• Sigmoid Colon (65%) & Caecum (30%) are the most common sites of volvulus in adults
  • Sigmoid Volvulus RFs → older patients, chronic constipation, chagas disease, neurological conditions (eg. parkinsons), psychiatric conditions (eg. schizophrenia)
  • Caecal Volvulus RFs → all ages, adhesions, pregnancy
• Volvulus in a neonate or infant presents as midgut volvulus secondary to intestinal malrotation

Making Diagnosis

Clinical Features:

• History of abdominal pain → decreases after explosive passage of stool/gas
• Slowly progressive symptoms of bowel obstruction → abdominal pain, distension, bilious vomiting
• Constipation
• Bowel Ischaemia → tachycardia, hypotension, peritonitis (rebound tenderness)
• Caecal Volvulus → features of SBO & recurrent episodes of RLQ abdominal pain
• Gastric Volvulus → failure to pass NG tube (along with epigastric pain and vomiting)
• Midgut Volvulus in Infants → bilious vomiting, haematochezia, haematemesis, hypotension, tachycardia

Investigations: