Volvulus may be defined as torsion of the colon around it's mesenteric axis resulting in compromised blood flow and closed loop obstruction.

Sigmoid volvulus (around 80% of cases) describes large bowel obstruction caused by the sigmoid colon twisting on the sigmoid mesocolon. A similar problem may also occur at the caecum (20% of cases). In most people (around 80%) the caecum is a retroperitoneal structure so not at risk of twisting. In the remaining minority there is however developmental failure of peritoneal fixation of the proximal bowel putting these patients at risk of caecal volvulus.

PC

• constipation
• abdominal bloating
• abdominal pain
• nausea/vomiting

Investigations

• usually diagnosed on the abdominal film
• sigmoid volvulus: large bowel obstruction (large, dilated loop of colon, often with air-fluid levels) + coffee bean sign
• caecal volvulus: small bowel obstruction may be seen

Management

• sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
  • Large bowel decompression with a flatus tube may suffice in some patients
  • If recurrent may require sigmoid colonoscopy
  • In patients with sigmoid volvulus who have bowel obstruction with symptoms of peritonitis, skip the flexible sigmoidoscopy and treat with urgent midline laparotomy
• caecal volvulus: management is usually operative. Right hemicolectomy is often needed