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
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Midgut Volvulus
- Associated with Intestinal Malrotation
- Presents in infants in 90% of cases
-
Sigmoid Volvulus
- Presents in the elderly with Abdominal Pain, Abdominal Distention and obstipation (unable to pass stool or Flatus)
-
Gastric Volvulus
- Rare condition that occurs in the elderly, typically due large paraesophageal Hiatal Hernias
- Infants represent 20% of cases, typically due to congenital Diaphragmatic Hernia
III. Signs
- Abdominal exam may be benign
-
Heme positive stool
- Late sign suggesting infarcted bowel
IV. Differential Diagnosis
- See Abdominal Pain Causes
V. Complications
- Intestinal infarction (high mortality)
VI. Management
- Emergent surgical management
- Mesenteric Infarction and necrosis starts within first 3 hours of onset
VII. References
- Hebra (2012) Intestinal Volvulus, Medscape