Volvulus, Intestinal Volvulus

  • Definitions
  1. Volvulus
    1. Twisting of intestinal loop around attachment to mesentery
    2. Can occur at Stomach (Gastric Volvulus), Small Intestine, cecum, transverse colon or sigmoid colon
  2. Midgut Volvulus
    1. Associated with Intestinal Malrotation
    2. Presents in infants in 90% of cases
  3. Sigmoid Volvulus
    1. Presents in the elderly with Abdominal Pain, Abdominal Distention and obstipation (unable to pass stool or Flatus)
  4. Gastric Volvulus
    1. Rare condition that occurs in the elderly, typically due large paraesophageal Hiatal Hernias
    2. Infants represent 20% of cases, typically due to congenital Diaphragmatic Hernia
  • Signs
  1. Abdominal exam may be benign
  2. Heme positive stool
    1. Late sign suggesting infarcted bowel
  • Differential Diagnosis
  1. See Abdominal Pain Causes
  • Complications
  1. Intestinal infarction (high mortality)
  • Management
  1. Emergent surgical management
    1. Mesenteric Infarction and necrosis starts within first 3 hours of onset
  • References
  1. Hebra (2012) Intestinal Volvulus, Medscape