Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Volvulus
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
This important condition has a significant morbidity and mortality and therefore requires a high index of suspicion. It can be missed as it often presents in the elderly and infirm.
Definition and classification
Volvulus is a rotation of a segment of bowel about its longitudinal mesenteric axis, resulting in occlusion of the proximal section. It most commonly affects the colon (the sigmoid and caecum) although small bowel (usually the lower ileum) or stomach may also be affected. It can be classified as primary (i.e. caused by congenital intestinal malrotation, abnormal mesenteric attachments or congenital ‘Ladd's’ bands), or secondary (more common), and can be either acute or chronic.
Incidence
Sigmoid volvulus is the most common type and is responsible for approximately 8% of all intestinal obstructions. Men are more commonly affected than women, most commonly in the sixth decade of life. Caecal volvulus is more common in women.
Aetiology
Associated with increasing age, chronic constipation, a high-roughage diet, lead poisoning, neurological conditions (e.g. Parkinson's disease), Surgical emergencies Hirschsprung's disease, patients in nursing homes and mental health facilities. Can be caused by round-worm infection and Chagas disease. Incomplete midgut rotation predisposes to caecal volvulus.
Pathology
Macroscopic: volvulus occurs secondary to a narrow mesentery in association with a long redundant sigmoid allowing two segments of bowel to come together and twist around the axis, usually anticlockwise in the case of the sigmoid volvulus, varying from 180° (35%) to 540° (10%) (Figure 43). Caecal volvulus usually involves clockwise axial rotation of terminal ileum, caecum and ascending colon around ileocolic vessels and mesentery (Figure 44). Microscopic: venous congestion andarterial compromise cause ischaemia and infarction.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 241 - 246Publisher: Cambridge University PressPrint publication year: 2009