Volvulus
Volvulus is a topic covered in the 5-Minute Emergency Consult.
To view the entire topic, please sign in or purchase a subscription.
Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
-- The first section of this topic is shown below --
Basics
Description
Description
- Axial twist of a portion of the GI tract around its mesentery causing partial or complete obstruction of the bowel
- Often associated with other GI abnormalities
- In pediatric setting, infants typically involved:
- Abnormal embryonic development
- Can be precipitated by pathologic distention of the colon
- Blood supply may be compromised by venous congestion and eventual arterial inflow obstruction, leading to gangrene of the bowel and potential infarction
Etiology
Etiology
- 3rd most common cause of colonic obstruction (10–15%) following tumor and diverticular disease
- Epidemiology:
- 0–1 yo: 30%
- 1–18 yo: 20%
- Over 18 yo: 50%
- Often associated with other GI abnormalities
- Cecum (52%):
- More common in young adults, < 50 yr old
- Due to improper congenital fusion of the mesentery with the posterior parietal peritoneum, causing the cecum to be freely mobile in varying degrees
- Associated with increased gas production (malabsorption and pseudo-obstruction)
- Can be seen in pregnancy and after colonoscopy
- Sigmoid (43%):
- More common in:
- Elderly
- Institutionalized
- Chronic bowel motility disorders (Parkinson)
- Psychiatric diseases (schizophrenia)
- Due to redundant sigmoid colon with narrow mesenteric attachment
- Associated with chronic constipation and concomitant laxative use
- More common in:
- Transverse colon and splenic flexure (5%)
- Gastric volvulus (rare) associated with diaphragmatic defects
Pediatric Considerations
- Midgut volvulus:
- Due to congenital malrotation in which the midgut fails to rotate properly in utero as it enters the abdomen
- Entire midgut from the descending duodenum to the transverse colon rotates around its mesenteric stalk, including the superior mesenteric artery
- Common in neonates (80% <1 mo old, often in 1st week; 6–20% >1 yr old)
- Males > females, 2:1
- Sudden onset of bilious emesis (97%) with abdominal pain
- May have previous episodes of feeding problems/bilious emesis
- In children >1 yr old, associated with failure to thrive, alleged intolerance to feedings, chronic intermittent vomiting, bloody diarrhea
- Constipation
- Mild distention, since obstruction higher in GI tract
- May not appear toxic based on degree of ischemia
-- To view the remaining sections of this topic, please sign in or purchase a subscription --
Citation
Rosen, Peter, et al., editors. "Volvulus." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/1.3/Volvulus.
Volvulus. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/1.3/Volvulus. Accessed December 5, 2019.
Volvulus. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/1.3/Volvulus
Volvulus [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 December 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/1.3/Volvulus.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Volvulus
ID - 307280
ED - Rosen,Peter,
ED - Shayne,Philip,
ED - Barkin,Adam Z,
ED - Wolfe,Richard E,
ED - Hayden,Stephen R,
ED - Barkin,Roger M,
ED - Schaider,Jeffrey J,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307280/1.3/Volvulus
PB - Lippincott Williams & Wilkins
ET - 5
DB - Emergency Central
DP - Unbound Medicine
ER -