High-yield map
Key points before the detail
- 01
Volvulus is obstruction plus a vascular threat.
- 02
CT identifies the twist and signs of ischaemia.
- 03
Uncomplicated sigmoid volvulus: endoscopic detorsion then definitive resection.
- 04
Caecal volvulus usually requires surgery.
- 05
Peritonitis or non-viable bowel means emergency resection without endoscopic delay.
1. Mechanism and predisposing anatomy
| Type | Typical setting |
|---|---|
| Sigmoid | Long redundant sigmoid with narrow mesenteric base; chronic constipation, immobility, neuropsychiatric disease or megacolon. |
| Caecal | Mobile right colon from failure of retroperitoneal fixation; sometimes younger patients or after pregnancy/surgery. |
2. Presentation and danger signs
- Distension, colicky pain, vomiting and obstipation.
- Continuous pain, fever, tachycardia, guarding, shock or raised lactate suggest ischaemia/perforation.
- Do not wait for dramatic peritonism in frail patients when CT shows threatened bowel.
3. Investigation
- Resuscitate while investigating and obtain lactate and crossmatch according to severity.
- Plain radiography may show a coffee-bean loop but is not always diagnostic.
- Contrast CT identifies the transition/twist, mesenteric whirl, closed loop and signs of bowel compromise.
4. Sigmoid volvulus
| State | Management |
|---|---|
| No ischaemia/perforation/peritonitis | Urgent flexible sigmoidoscopic detorsion with minimal insufflation and mucosal inspection. |
| Successful decompression | Plan definitive sigmoid colectomy during the same admission or early planned period because recurrence is common. |
| Failed detorsion or non-viable mucosa | Emergency surgery. |
| Peritonitis, perforation, shock or gangrene | Emergency resection; do not attempt endoscopic detorsion. |
5. Caecal volvulus
Endoscopic decompression is unreliable and may delay definitive treatment. Surgery is the usual treatment even when bowel appears viable.
- Resect non-viable or perforated bowel.
- Right hemicolectomy/ileocolic resection with primary anastomosis is appropriate when physiology and contamination permit.
- Use a stoma or staged strategy when shock or contamination makes anastomosis unsafe.
6. After decompression
- Symptom relief after sigmoid detorsion is not cure.
- Address constipation, frailty, mobility and neuroactive medicines.
- Consider colon assessment or histology when underlying distal lesions or megacolon remain a concern.
Active recall
Close the notes and answer these
Try each question from memory before revealing the answer. These public prompts are a small preview of the integrated retrieval system inside SurgAtlas.
01Why is volvulus more than a simple obstruction?
The twist also threatens mesenteric blood flow, so bowel can become ischaemic, gangrenous and perforate.
02What is first-line treatment for uncomplicated sigmoid volvulus?
Urgent endoscopic detorsion/decompression with mucosal assessment.
03What should follow successful sigmoid decompression?
Definitive sigmoid resection during the same admission or early planned period because recurrence is common.
04Is endoscopic decompression standard for caecal volvulus?
No. Caecal volvulus is usually treated surgically.
05What finding rules out endoscopic detorsion?
Peritonitis, perforation, shock, gangrene or evidence of non-viable bowel.
Sources & editorial basis
References & editorial basis
- SurgAtlas production source. General Surgery — Volvulus. Public lesson curated from the corresponding production chapter.
- ACPGBI / ASCRS source guidance. Emergency colorectal surgery and colonic volvulus guidance as recorded in the SurgAtlas source register.
This lesson is derived from the corresponding SurgAtlas production teaching material. Where the source makes current management or guideline claims, the public lesson uses the cited contemporary guidance. It is written for education and examination preparation, not as patient-specific clinical advice.
Editorial details
Medical Doctor (MD) · MRCS Part A · Physician · Surgical Educator
SurgAtlas is an educational resource. For patient care, verify current national guidance, local antimicrobial and transfusion policies, specialty pathways and individual patient factors.
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