see also: [[Volvulus|volvulus (paeds)]] # Overview - type of Large [[Bowel obstruction]] - twisting of an intestinal segment on its mesenteric axis sufficient to cause bowel obstruction - occurs in patients with *severe chronic constipation* - most common in debilitated elderly people - often late presentation > n.b. is different from caecal volvulus, which is usually young adults ## History - pain may overlooked or difficult to assess - vomiting a late sign - diffuse abdo tenderness and distension - tympanic percussion ## Risk factors - chronic constipation - elderly - chronic neurological conditions (PKD, MS) - laxative abuse ## Management **ED**: - analgesia - antiemetics (likely not maxalon) - fluid and electrolyte replacement - gastric decompression -- NGT - +/- abx if evidence of perforation/sepsis - obviously refer to Gen Surg **Surgical treatments:** - rectal tube decompression by sigmoidoscopy successful in 90% of pts (endoscopic detorsion) - indicated if no evidence of ischemia/perforation/peritonitis and viable colon - surgery (laparotomy w/ colon resection +/- stoma) if failure of decompression or suspected strangulation / ischemia / perforation / peritonitis ## Complications - bowel perforation leading to peritonitis - strangulation causing [[Mesenteric ischaemia|bowel ischaemia]] # imaging XRs shows single dilated loop of colon. both ends of loop oriented towards pelvis ![[Pasted image 20240725204944.png]] ![[Pasted image 20240725205001.png]] ![[Pasted image 20240725214859.png]] ![[Pasted image 20241102101604.png]] "coffee bean" appearance with distended bowel toward RUQ