II. Definitions
-
Volvulus
- Twisting of intestinal loop around attachment to mesentery
- Can occur at Stomach (Gastric Volvulus), Small Intestine, cecum, transverse colon or sigmoid colon
III. Epidemiology
- Typically occurs in elderly
IV. Symptoms: Sigmoid Volvulus
- Abdominal Pain
- Abdominal Distention
- Obstipation (unable to pass stool or Flatus)
- Vomiting is a late and ominous sign
V. Signs
- Abdominal exam may be benign
-
Heme positive stool
- Late sign suggesting infarcted bowel
VI. Differential Diagnosis
- See Abdominal Pain Causes
VII. Complications
- Intestinal infarction (high mortality)
VIII. Management
- Emergent surgical management
- Mesenteric Infarction and necrosis starts within first 3 hours of onset
IX. References
- Hebra (2012) Intestinal Volvulus, Medscape