Surg: Volvulus: Free MSRA Podcast

🎙️MSRA Podcast:Volvulus – A Critical Twist in the GutToday’s episodetackles one of the most dangerous causes ofacute abdominal pain: Volvulus.From green vomit inneonates to sudden obstruction in elderly adults, we unravel the twisting pathology, clinical signs, andessential investigations you need to know for exams like the MSRA andreal-world clinical scenarios. 🔄What is Volvulus?• A twist of the bowel around its mesentericattachment• Leads to bowel obstruction and compromised blood flow• Can affect the sigmoid colon, caecum, small intestine, or stomach• When linked tocongenital issues, especially in children, it's often due to midgut malrotation 📦Causes & RiskFactors• Congenital malrotation (especially in infants)• Chronic constipation• Adhesions from past abdominal surgery• Neurological or motility disorders (e.g.,Parkinson’s)• Connective tissue disorders• Advanced age andanatomical variants (e.g., long mesentery)🧠Mnemonic: “V forVolvulus = Vascular + Volumetric Twist” 🧠Pathophysiology• Intestinal looptwists → mechanical blockage• Simultaneouslycuts off blood supply → ischemia → necrosis →perforation• Malrotation often underlies midgut volvulus,especially in neonates• Surgical emergencydue to rapid onset of tissue death and sepsisrisk 📊Epidemiology• Rare but serious• Midgut malrotation occurs in ~1 in 500 to 1 in2,500 live births• Most malrotation presents in infancy, but can remain silent into adulthood• Volvulus is more common in older adults, particularly with predisposingfactors 🩺Clinical Features• Sudden abdominal pain, vomiting, distension• Inability to pass gas or stool• In neonates: green (bilious) vomiting is a red flag• In severe cases: shock, peritonitis,bloody stools, palpable abdominal mass🧠Mnemonic: “V’s forVolvulus” – Vomiting, Very painful abdomen, no Voluntary bowel movements 🔍Differential Diagnosis• General bowelobstruction• Appendicitis• Gastroenteritis• IBS• Intussusception• Meckel’sdiverticulum• Pancreatitis• In females:ovarian torsion• In neonates:Hirschsprung’s, NEC, pyloric stenosis 🧪Investigations• Abdominal X-ray – Look for “coffee bean” sign (sigmoid)• CT scan – Detailed visualisation of the twistand complications• Upper GI contrast study – Especially useful formalrotation (bird’s beak sign)• Ultrasound with Doppler – Can show “whirlpool sign” of twisted vessels• Bloods: FBC,U&Es, lactate, CRP, infection markers🧠Green vomiting =investigate immediately with contrast study or ultrasound 🛠️Management• Definitive treatment = surgery• Supportive care: fluids, antibiotics,electrolyte correction• Proceduresinclude:– Sigmoidoscopy for decompression (sigmoidvolvulus only)– Right hemicolectomy for caecal volvulus– Ladd’s procedure for volvulus due tomalrotation• Laparoscopic options preferred when feasible• In emergencies: resection of necrotic bowel may be required ⚠️Complications• Bowel ischemia → necrosis,perforation, peritonitis, sepsis• Short bowel syndrome – following resection• Nutritional deficiencies, parenteral nutrition dependence• Post-op adhesions, recurrence risk if nottreated definitively🧠 Prevention in malrotation: elective Ladd’s procedure increasingly recommended even if asymptomatic 📚Volvulus MSRARevision Resources📝 Revision Noteshttps://www.passthemsra.com/topic/volvulus-revision-notes/🃏 Flashcardshttps://www.passthemsra.com/topic/volvulus-flashcards/📖 Accordion Q&A Noteshttps://www.passthemsra.com/topic/volvulus-accordion-qa-notes/🧠 Rapid Quizhttps://www.passthemsra.com/topic/volvulus-rapid-quiz/🧠Think twist +obstruction + ischemia = emergencyCheck out morehigh-yield revision at:🌐https://www.passthemsra.com🌐https://www.freemsra.com#MSRA #Volvulus#GreenVomit #SurgicalEmergency #Paediatrics #AcuteAbdomen #MSRAFlashcards#MSRARevisionNotes #PassTheMSRA #CoffeeBeanSign #LaddsProcedure #Malrotation#GIRevision #WhirlpoolSign #ShortBowelSyndrome