Gastroenterology & Nutrition

Volvulus

Volvulus is twisting of bowel around its mesentery, causing a closed-loop obstruction and threatening the blood supply; sigmoid volvulus may be detorted endoscopically when uncomplicated, whereas caecal and paediatric midgut volvulus generally require urgent surgical management.

Definition

Volvulus is twisting of a segment of bowel around its mesenteric axis, causing a closed-loop obstruction and possible compromise of the mesenteric blood supply. In adults it most often affects the sigmoid colon or caecum; in infants it may complicate intestinal malrotation as midgut volvulus.

First principles

A mobile, redundant loop can rotate around its mesentery

Volvulus occurs when a mobile or redundant bowel segment twists around its mesenteric attachment. In adults the colon is the commonest site, especially the sigmoid and caecum; in infants and children, malrotation can leave the midgut on a narrow mesenteric base that can twist around the superior mesenteric artery.

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