How can you distinguish between sigmoid volvulus and cecal volvulus?

Whereas sigmoid volvulus is usually an acquired condition, cecal volvulus is due to congenital incomplete dorsal mesenteric fixation of the cecum or ascending colon associated with an abnormally elongated mesentery distal to this area of absent mesentery.

What is the pathophysiology of volvulus?

Volvulus occurs when a loop of intestine twists around itself and the mesentery that supplies it, causing a bowel obstruction. Symptoms include abdominal distension, pain, vomiting, constipation, and bloody stools. The onset of symptoms may be insidious or sudden.

How is cecal volvulus treated?

The procedure for treating cecal volvulus is called a cecopexy. Your surgeon will move the cecum back to its proper position in the abdominal wall. Intestinal resection surgery. If the cecum is severely damaged from being twisted, your doctor may recommend intestinal resection surgery.

How is sigmoid volvulus diagnosed?

Plain abdominal radiographic findings are usually diagnostic of sigmoid volvulus. Decompression may be achieved by the introduction of a stiff tube per rectum, aided by endoscopy or fluoroscopy. A single-contrast barium enema examination is usually adequate if it is required, as in cases when the diagnosis is in doubt.

What does a cecal volvulus look like?

The small-bowel loops are distended with fluid, and to-and-fro peristalsis is often visible. Cecal volvulus may be depicted as a grossly distended fluid-filled cecum at a lead point of small-bowel obstruction, but the appearances are generally nonspecific.

What causes cecal volvulus?

Cecal volvulus is caused by axial twisting of the cecum along with the terminal ileum and ascending colon [2]. It is responsible for approximately 1–1.5% of all intestinal obstructions, while 11% of all volvulus-related intestinal obstructions, and its incidence is 2.8–7.1 cases per million annually [1].

What is the difference between torsion and volvulus?

Intestinal torsion describes the twisting of the bowel on its longitudinal axis, causing luminal obstruction, whilst intestinal volvulus describes a rotation about the mesenteric axis. Both may occur concurrently.

What is the difference between Malrotation and volvulus?

Malrotation causes the parts of the intestine to settle in the wrong part of the abdomen, which can cause them to become blocked or to twist. Intestinal volvulus is a condition in which the bowel becomes twisted, which may be the result of malrotation.

Is cecal volvulus an emergency?

The management of cecal volvulus requires prompt (emergency) diagnosis and prompt surgical intervention. Any delay in diagnosis may lead to intestinal necrosis or perforation and worsening the prognosis in patients who are generally elderly.

Can volvulus be treated without surgery?

Share on Pinterest A volvulus needs immediate treatment and usually requires surgery. Prompt diagnosis of volvulus can help lead to successful treatment and better outcomes. If a person shows signs of having a volvulus, a doctor will do a physical examination and ask the person about their medical history.

Why is sigmoid volvulus serious?

This situation can lead to death of the blood-starved tissue and tearing of the intestinal wall—a life-threatening event and a medical emergency. Sigmoid volvulus—twisting of the sigmoid colon—accounts for the majority of cases, with cecal volvulus—twisting of the cecum and ascending colon—occurring less frequently.

How painful is sigmoid volvulus?

Most often sigmoid volvulus presents with sudden-onset colicky lower abdominal pain associated with gross abdominal distension and a failure to pass either flatus or stool. It may present insidiously with chronic abdominal distension, constipation, vague and usually colicky lower abdominal discomfort and vomiting.

Is the cecal bascule the same as a sigmoid volvulus?

Cecal volvulus may be organoaxial (true cecal or cecocolic volvulus) or mesentericoaxial (cecal bascule). The former involves the distal ileum and ascending colon twisting around each other, in much the same way as a sigmoid volvulus.

How to tell if you have cecal volvulus?

Patients with a cecal volvulus will usually present with both small bowel and large bowel obstructions, with collapse of the distal large bowel and extensive dilatation of the proximal small bowel. According to studies, a definitive sign of a cecal volvulus is upward displacement of the appendix and obstruction of the large bowel. [ 2]

What kind of resection is needed for Sigmoid volvulus?

Extent of resection required for sigmoid volvulus is limited to resection of omega loop of sigmoid volvulus and resection of sigmoid mesentery. Divided descending colon and rectum are reanastomosed in hand-sewn manner or with GI stapling device.

Where does the cecum fold in a volvulus?

In the cecal bascule type of volvulus, the cecum folds anteromedial to the ascending colon, with the production of a flap-valve occlusion at the site of flexion. This form of torsion occurs in a transverse plane and is associated with marked distention of the cecum, which is often displaced into the center of the abdomen.