Volvulus - Revision history

Ostermayer at 18:04, 16 January 2026

2026-01-16T18:04:26Z

← Revisión anterior		Revisión del 18:04 16 ene 2026
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	{{~~Adult top~~}}		{{AdultPage\|volvulus (peds)}}
	<translate> ~~[[Special:MyLanguage/volvulus (peds)\|volvulus (peds)]].''~~		<translate>

	==Backgound==		==Backgound==

Ostermayer: Prepared the page for translation

2026-01-05T00:03:30Z

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Elcatracho: /* Evaluation */

2021-01-20T17:14:29Z

Evaluation

← Revisión anterior		Revisión del 17:14 20 ene 2021
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	==Evaluation==		==Evaluation==
	[[File:CecalVolvulusXray.png\|thumb\|Abdominal X-ray of a cecal volvulus]]		[[File:CecalVolvulusXray.png\|thumb\|Abdominal X-ray of a cecal volvulus]]
			[[File:Sigmoidvolvulus.jpg\|thumb\|Abdominal X-ray of a sigmoid volvulus]]
	[[File:Volvulus.png\|thumb\|Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock.]]		[[File:Volvulus.png\|thumb\|Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock.]]
	===Workup===		===Workup===

Rossdonaldson1 at 19:16, 23 January 2020

2020-01-23T19:16:16Z

← Revisión anterior		Revisión del 19:16 23 ene 2020
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	~~''This page is for '''adult''' patients; for pediatric patients see~~ [[volvulus (peds)]].''		{{Adult top}} [[volvulus (peds)]].''
	==Backgound==		==Backgound==
	[[File:Volvulus (Dickdarm).jpg\|thumb\|Volvulus with gangrene of the sigmoid.]]		[[File:Volvulus (Dickdarm).jpg\|thumb\|Volvulus with gangrene of the sigmoid.]]

ClaireLewis at 16:52, 30 September 2019

2019-09-30T16:52:21Z

← Revisión anterior		Revisión del 16:52 30 sep 2019
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	===Evaluation===		===Evaluation===
	*[[Gastric volvulus]]		*[[Gastric volvulus]]
	**Upright CXR and abdominal XR		**Upright [[CXR]] and [[abdominal Xray]]
	***Intrathoracic, upside-down stomach		***Intrathoracic, upside-down stomach
	***Double air fluid level in stomach		***Double air fluid level in stomach
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	***Ischemia seen a lack of contrast enhancement of gastric wall		***Ischemia seen a lack of contrast enhancement of gastric wall
	*Cecal Volvulus		*Cecal Volvulus
	**Abdominal Series X-rays		**[[KUB\|Abdominal Series X-rays]]
	***Not definitive in many cases		***Not definitive in many cases
	***Dilated cecum with air fluid level		***Dilated cecum with air fluid level
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	**Contrast enema		**Contrast enema
	***Helpful to differentiate between sigmoid/cecal volvulus		***Helpful to differentiate between sigmoid/cecal volvulus
	**Ultrasound		**[[ultrasound: Abdomen\|Ultrasound]]
	***Not particularly helpful		***Not particularly helpful
	**CT		**CT
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	**Many only definitively diagnosed at surgery		**Many only definitively diagnosed at surgery
	*Sigmoid Volvulus		*Sigmoid Volvulus
	**Abdominal Series X-rays		**[[KUB\|Abdominal Series X-rays]]
	***May not be diagnostic		***May not be diagnostic
	***Grossly distended loop of colon (no haustral markings) either on R/L side.		***Grossly distended loop of colon (no haustral markings) either on R/L side.
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	==Management==		==Management==
	*Fluid resuscitation		*[[Fluid resuscitation]]
	*[[Analgesia]]		*[[Analgesia]]
	*[[Antibiotics]] with bowel coverage if perforation or gangrene suspected (e.g. [[ceftriaxone]] plus [[flagyl]])		*[[Antibiotics]] with bowel coverage if perforation or gangrene suspected (e.g. [[ceftriaxone]] plus [[flagyl]])
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	[[Category:GI]]		[[Category:GI]]
			[[category:Surgery]]

ClaireLewis: /* Management */

2019-09-24T17:18:22Z

Management

← Revisión anterior		Revisión del 17:18 24 sep 2019
Línea 91:		Línea 91:
	==Management==		==Management==
	*Fluid resuscitation		*Fluid resuscitation
	*Analgesia		*[[Analgesia]]
	*[[Antibiotics]] with bowel coverage if perforation or gangrene suspected (e.g. [[ceftriaxone]] plus [[flagyl]])		*[[Antibiotics]] with bowel coverage if perforation or gangrene suspected (e.g. [[ceftriaxone]] plus [[flagyl]])
	*Emergent surgery consult		*Emergent surgery consult

ClaireLewis at 16:35, 10 September 2019

2019-09-10T16:35:32Z

← Revisión anterior		Revisión del 16:35 10 sep 2019
Línea 2:		Línea 2:
	==Backgound==		==Backgound==
	[[File:Volvulus (Dickdarm).jpg\|thumb\|Volvulus with gangrene of the sigmoid.]]		[[File:Volvulus (Dickdarm).jpg\|thumb\|Volvulus with gangrene of the sigmoid.]]
	*Twisting of loop of bowel causing bowel obstruction and (if severe) ischemia, gangrene, perforation		*Twisting of loop of bowel causing [[bowel obstruction]] and (if severe) ischemia, gangrene, perforation
	*Generally affects adults aged 60-70		*Generally affects adults aged 60-70
	*Can cause severe ~~thirdspacing~~, electrolyte abnormality, and abdominal distention		*Can cause severe third-spacing, [[electrolyte abnormality]], and abdominal distention
	*Common sites include cecum and sigmoid		*Common sites include cecum and sigmoid
	**Cecal volvulus - mobile segment of cecum causing volvulus and cecal folding		**Cecal volvulus - mobile segment of cecum causing volvulus and cecal folding
	**Sigmoid volvulus - redundant sigmoid attached to narrow mesentery twists on itself causing obstruction and further ~~diation~~		**Sigmoid volvulus - redundant sigmoid attached to narrow mesentery twists on itself causing obstruction and further dilation

	===Risk Factors<ref>Weerakkody Y et al. Caecal volvulus. http://radiopaedia.org/articles/caecal-volvulus.</ref><ref>Morgan MA et al. Sigmoid volvulus. http://radiopaedia.org/articles/sigmoid-volvulus</ref>===		===Risk Factors<ref>Weerakkody Y et al. Caecal volvulus. http://radiopaedia.org/articles/caecal-volvulus.</ref><ref>Morgan MA et al. Sigmoid volvulus. http://radiopaedia.org/articles/sigmoid-volvulus</ref>===
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	**More common in elderly as opposed to cecal volvulus		**More common in elderly as opposed to cecal volvulus
	**High fiber diet		**High fiber diet
	**Chronic constipation		**Chronic [[constipation]]
	**Chagas disease		**[[Chagas disease]]
	**Patients of long term care facilities/psychiatric institutions		**Patients of long term care facilities/psychiatric institutions
	*Cecal volvulus		*Cecal volvulus
	**Most between 30-60 years of age		**Most between 30-60 years of age
	**Prior abdominal surgery		**Prior abdominal surgery
	**Pelvic mass, 3rd trimester pregnancy		**Pelvic mass, 3rd trimester [[pregnancy]]
	**Cecal mobility cause by congenital abnormality with cecal mesentery failing to fuse with posterior abdominal wall		**Cecal mobility cause by congenital abnormality with cecal mesentery failing to fuse with posterior abdominal wall
	*Gastric volvulus		*[[Gastric volvulus]]
	**Most common between 40-50 years of age		**Most common between 40-50 years of age
	**Paraesophageal hernias		**Paraesophageal hernias
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	==Clinical Features==		==Clinical Features==
	===Sigmoid/Cecal volvulus===		===Sigmoid/Cecal volvulus===
	*Triad: Abdominal pain, distention, constipation		*Triad: [[Abdominal pain]], distention, [[constipation]]
	*Vomiting only occurs late as obstruction is rather distal. If so, may be ~~faeculant~~ in nature and indicates long-standing obstruction.		*[[Vomiting]] only occurs late as obstruction is rather distal. If so, may be feculent in nature and indicates long-standing obstruction.
	*Vary from subtle to dramatic presentations		*Vary from subtle to dramatic presentations
	*Physical Exam:		*Physical Exam:
	**Distended, tympanitic abdomen (mostly upper abdomen and unilateral)		**Distended, tympanitic abdomen (mostly upper abdomen and unilateral)
	**Severe abdominal tenderness, peritonitis, fever, shock highly suggestive for gangrenous bowel		**Severe abdominal tenderness, [[peritonitis]], [[fever]], [[shock]] highly suggestive for gangrenous bowel

	===Gastric volvulus (Borchardt's triad)===		===[[Gastric volvulus]] (Borchardt's triad)===
	*Abdominal and/or chest pain		*[[Abdominal pain\|Abdominal]] and/or [[chest pain]]
	*Retching, vomiting		*Retching, [[vomiting]]
	*Inability to pass NGT		*Inability to pass NGT

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	===Workup===		===Workup===
	*CBC, chem 7		*CBC, chem 7
	*LFTs, lipase, PT/PTT		*[[LFTs]], lipase, PT/PTT
	*~~Lactic acid~~		*[[Lactate]]
	*UA, Upreg (if female)		*[[UA]], Upreg (if female)
	*CT abdomen/pelvis		*CT abdomen/pelvis

	===Evaluation===		===Evaluation===
	*Gastric volvulus		*[[Gastric volvulus]]
	**Upright CXR and abdominal XR		**Upright CXR and abdominal XR
	***Intrathoracic, upside-down stomach		***Intrathoracic, upside-down stomach
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	*[[Antibiotics]] with bowel coverage if perforation or gangrene suspected (e.g. [[ceftriaxone]] plus [[flagyl]])		*[[Antibiotics]] with bowel coverage if perforation or gangrene suspected (e.g. [[ceftriaxone]] plus [[flagyl]])
	*Emergent surgery consult		*Emergent surgery consult
	**Gastric volvulus		**[[Gastric volvulus]]
	***Endoscopic reduction		***Endoscopic reduction
	***Recurrence possible, which would mandate surgical repair		***Recurrence possible, which would mandate surgical repair

Rossdonaldson1: /* Management */

2019-06-24T22:09:18Z

Management

← Revisión anterior		Revisión del 22:09 24 jun 2019
Línea 90:		Línea 90:

	==Management==		==Management==
	*Emergent surgery consult
	*Fluid resuscitation		*Fluid resuscitation
	*Analgesia		*Analgesia
	*Antibiotics if perforation or gangrene suspected		*[[Antibiotics]] with bowel coverage if perforation or gangrene suspected (e.g. [[ceftriaxone]] plus [[flagyl]])
	*~~Sigmoid~~ volvulus ~~may be managed with endoscopic decompression/detorsion (if no signs of gangrenous bowel/perforation)~~		*Emergent surgery consult
	**Recurrence possible, which would mandate surgical repair		**Gastric volvulus
	*Cecal volvulus always requires surgical repair with resection (preferred) or cecopexy		***Endoscopic reduction
	*~~Gastric volvulus~~		***Recurrence possible, which would mandate surgical repair
	**Endoscopic reduction		**Cecal volvulus always requires surgical repair with resection (preferred) or cecopexy
	**Endoscopy relatively contraindicated in signs of ischemia such as significantly elevated lactate		***Endoscopy relatively contraindicated in signs of ischemia such as significantly elevated lactate
			**Sigmoid volvulus may be managed with endoscopic decompression/detorsion (if no signs of gangrenous bowel/perforation)

	==Disposition==		==Disposition==

Rossdonaldson1: /* Workup */

2019-06-24T22:07:24Z

Workup

← Revisión anterior		Revisión del 22:07 24 jun 2019
Línea 47:		Línea 47:
	[[File:Volvulus.png\|thumb\|Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock.]]		[[File:Volvulus.png\|thumb\|Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock.]]
	===Workup===		===Workup===
	*Lactic acid
	*CBC, chem 7		*CBC, chem 7
	*LFTs, lipase, PT/PTT		*LFTs, lipase, PT/PTT
			*Lactic acid
			*UA, Upreg (if female)
	*CT abdomen/pelvis		*CT abdomen/pelvis
	*UA, Upreg (if female)

	===Evaluation===		===Evaluation===

Rossdonaldson1: /* Workup */

2019-06-24T22:06:57Z

Workup

← Revisión anterior		Revisión del 22:06 24 jun 2019
Línea 51:		Línea 51:
	*LFTs, lipase, PT/PTT		*LFTs, lipase, PT/PTT
	*CT abdomen/pelvis		*CT abdomen/pelvis
	*UA		*UA, Upreg (if female)

	===Evaluation===		===Evaluation===