II. 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

III. Epidemiology

  1. Typically occurs in elderly

IV. Symptoms: Sigmoid Volvulus

  1. Abdominal Pain
  2. Abdominal Distention
  3. Obstipation (unable to pass stool or Flatus)
  4. Vomiting is a late and ominous sign

V. Signs

  1. Abdominal exam may be benign
  2. Heme positive stool
    1. Late sign suggesting infarcted bowel

VI. Differential Diagnosis

  1. See Abdominal Pain Causes

VII. Complications

  1. Intestinal infarction (high mortality)

VIII. Management

  1. Emergent surgical management
    1. Mesenteric Infarction and necrosis starts within first 3 hours of onset

IX. References

  1. Hebra (2012) Intestinal Volvulus, Medscape

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