volvulus

VOLVULUS

DEFINITION

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

TYPE

MIDGUT VOLVULUS

CECAL VOLVULUS

SIGMOID VOLVULUS

CAUSE

1. Chronic constipation ( type of Constipation ).

2. Abnormal intestinal contents (e.g. meconium ileus) or adhesions.

3.Congenital intestinal malrotation.(failure developed normal rotation)

RISK FACTOR

Paralytic ileusMegacolon

Hirschsprung’s disease

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 sign2.Rapid heart rate.3.Rapid breathing.

PATHOPHYSIOLOGY

•Redundant sigmoid colon that has a narrow mesenteric attachment to posterior abdominal wall allows close approximation of 2 limbs of sigmoid colon à twisting of sigmoid colon around mesenteric axis

DIAGNOSTIC TEST

1. X-rays — Abdominal X-rays may show obstruction and abnormal air-fluid levels in the sigmoid and cecum,in midgut volvulus, abdominal X-rays may be normal.

2. White blood cell count — In strangulation, the count is greater than 15,000/µl, in bowel infarction, greater than 20,000/µl.

CON’T…

3.Barium enema — In cecal volvulus, barium fills the colon distal to the section of cecum.

4.Computed tomography scan — may show evidence of intestinal obstruction.

X-RAY SHOWN

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 bowel. Expulsion of flatus and immediate relief of abdominal pain indicate success of nonsurgical reduction.

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)

4. If the bowel is necrotic, surgery includes resection and anastomosis.

COMPLICATION

1.Dehydration2.Ischemic bowel disease

3.Intestinal perforation

4.Peritonitis 5.Sepsis