Volvulus



Background

Can present any any age

Most seen in first month

Positive FHx, M:F = 2:1

Caused by malrotation

Abnormally fixed mesentry (normal bowel)

Signs and symptoms

  • Bilious vomiting (cf pyloric stenosis)
  • Dehydration and shock
  • Grunting respirations (beware airway compromise or peritonism)
  • Jaundice in about 1/3
  • Bloody stools (late sign)

Investigations

  • Dilated stomach and proximal duodenum, no gas distally
  • Air contrast may reveal the double bubble sign
  • Contrast studies - narrowing at site of obstruction
  • Spiraling of small bowel about the superior mesenteric artery (SMA)

Management

  • ABC’s
  • Fluid resuscitation
  • NPO/ NG tube
  • Antibiotic coverage (please check local policy

Content by Dr Íomhar O' Sullivan 01/12/2008. Last review Dr ÍOS 16/06/21.