Sigmoid volvulus and cecal volvulus

Last updated: February 22, 2022

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Volvulus is defined as the twisting of a loop of bowel on its mesentery and is one of the most common causes of intestinal obstruction. The sigmoid colon, and less frequently, the cecum, are the common sites of volvulus in adults. Patients typically show features of bowel obstruction (abdominal pain, distension, bilious vomiting) or of bowel ischemia and gangrene (tachycardia, hypotension, hematochezia, peritonitis) in severe cases. The whirl sign and a grossly dilated loop of bowel on an abdominal CT scan establish the diagnosis of volvulus in adults. Sigmoid volvulus without peritonitis is initially managed with endoscopic detorsion, followed by a semi-elective surgery (sigmoid colectomy). Sigmoid volvulus with peritonitis, and all cases of cecal volvulus, require emergency surgery. Endoscopic detorsion should not be attempted in a patient with cecal volvulus because of the high risk of perforation.

See “Midgut volvulus and intestinal malrotation” for volvulus in a neonate or infant.

SigmOid volvulus is more common in Older individuals while Midgut volvulus and Malrotation are more common in Minors.

Epidemiological data refers to the US, unless otherwise specified.

Risk factors

Sigmoid volvulus

Cecal volvulus

References:[7][8][9][10][11][12][13][14][15]

Differential diagnoses of sigmoid volvulus

Differential diagnoses of cecal volvulus

The differential diagnoses listed here are not exhaustive.

Treatment of sigmoid volvulus [16][17]

Treatment of cecal volvulus [19]

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