Synopsis
Recognise sigmoid and caecal volvulus, detect bowel ischaemia before attempting decompression, and coordinate endoscopic detorsion with definitive surgery to prevent recurrent obstruction.
- Volvulus is axial twisting of a mobile bowel segment and its mesentery, creating obstruction with progressive venous congestion, arterial compromise, necrosis and perforation.
- Sigmoid volvulus is associated with a redundant sigmoid, chronic constipation, neurological or psychiatric disease, immobility, institutional care and previous episodes.
- Caecal volvulus reflects abnormal right-colon mobility and often presents as a more acute obstruction in a younger or postoperative patient than sigmoid disease.
Key red flags
Massive painless or colicky distension, obstipation and a CT twist in sigmoid mesentery without free air, poor enhancement or peritonism supports urgent endoscopic detorsion.
Investigation priorities
Confirm the twist and site, distinguish sigmoid from caecal anatomy, identify a tumour and assess bowel viability or perforation.
Management branches
Acute distension, pain and obstipation suggest colonic volvulus.
- Keep fasting, obtain venous access, correct fluid and electrolyte deficits, provide analgesia and antiemetic care, and decompress the stomach when vomiting or small-bowel dilatation warrants it.
- Examine for peritonism and rectal findings, send urgent bloods and lactate, and obtain CT with direct radiology discussion about site, direction, viability and perforation.
Key medicines
Intravenous crystalloidGive reassessed isotonic fluid under the emergency-surgery protocol, replacing measured deficits and accounting for frailty, cardiac function, renal injury and urine output.
Broad-spectrum intravenous antibioticUse the current local enteric-sepsis regimen promptly when bowel ischaemia, perforation, systemic toxicity or emergency resection is suspected, then review against source control.