Colonic volvulus

• Derived from the Latin word volvere (“to twist”).
• Part of the colon twists on its mesentery, resulting in colonic obstruction.
• The main types:
  • Sigmoid volvulus (counterclockwise)
  • Cecal volvulus (clockwise direction)

Feature	Sigmoid Volvulus	Cecal Volvulus
Description	Twisting of the sigmoid colon	Torsion of the cecum
Extension	Upwards to the right upper quadrant	Any direction, including the pelvic area
Affected Population	Mostly elderly	Mostly young

Causes:

• High residue diet
• Bulky stool
• Tortious elongated colon
• Chronic constipation
• Laxatives abuse

Diagnosis:

• X-ray, contrast radiograph
• CT abdomen

Management:

In patients with no evidence of peritonitis or ischemic bowel

• Resuscitation
• Detorsion:

Sigmoid volvulus (success rate 90%)

• Sigmoidoscopy or Colonoscopy
• Rectal tube placement

Cecal volvulus (success rate 15-20)

• Cecostomy

Surgery:

• Open vs Lap
• Sigmoid resection/ Hartman’s (Sigmoid)
• Right hemicolectomy with ileocolic anastomosis (Cecal)
• Cecopexy is associated with volvulus recurrence in 20-30% of patients
• Unstable patient: surgery