Fact-sheet: Small bowel volvulus

Updated on 04/23/2019 at 9:53 AM

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Definition

high mechanical bowel obstruction due to the wrapping of afferent and efferent loops and their mesentery around a fixed point.

It may be of the following types:

- primary or idiopathic volvulus, for which no anatomic predisposition is found

- secondary volvulus, in which a congenital or acquired abnormality is identified

The most common causes:

acquired postoperative adhesions

tumor or carcinomatosis nodule

hernias with incarceration of one or more small bowel loops

Less commonly:

Ladd bands associated with intestinal malrotation

a long or ectopic appendix

a Meckel diverticulum

small bowel-type air-fluid level

coffee bean sign

dilated, aperistaltic small bowel loops

intraperitoneal effusion

Doppler ultrasound is particularly useful for the diagnosis of volvulus due to intestinal malrotation:

- interposition of the superior mesenteric artery and vein

- whirl of torsion around the superior mesenteric artery

C- or U-shaped configuration of the incarcerated loop

Radial distribution of the dilated loops and mesenteric vessels around the site of torsion

At the site of torsion:

- Whirl sign: swirling of the mesenteric vessels and mesentery converging toward the point of torsion

- Beak sign: tapering narrowing of the bowel caliber down to the point of obstruction

Hospitalization

Nasogastric tube placement

Correction of electrolyte imbalances

Surgical management.