Sigmoid and Cecal Volvulus Clinical Presentation

Updated: Dec 13, 2017
  • Author: Scott C Thornton, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History

Patients with volvulus are commonly elderly, debilitated, and bedridden. Often, the patient has a history of dementia or neuropsychiatric impairment. As a result, only a limited history is available.

More than 60-70% of patients present with acute symptoms; the remainder present with subacute or chronic symptoms. A history of chronic constipation is common. The patient may describe previous episodes of abdominal pain, distention, and obstipation, which suggest repeated subclinical episodes of volvulus.

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Physical Examination

The presentation of volvulus is much the same, regardless of its anatomic site. Cramping abdominal pain, distention, obstipation, and constipation are present. With progressive obstruction, nausea and vomiting occur. The development of constant abdominal pain is ominous and indicates the development of a closed-loop obstruction with significant intraluminal pressure. This, in turn, portends the development of ischemic gangrene and bowel wall perforation.

Abdominal distention is commonly massive and characteristically tympanitic over the gas-filled, thin-walled colon loop. Overlying or rebound tenderness raises the concern of peritonitis due to ischemic or perforated bowel. The patient may have a history of episodes of acute volvulus that spontaneously resolved; in such circumstances, marked abdominal distention with minimal tenderness may occur.

Depending on the extent of bowel ischemia or fecal peritonitis, signs of systemic toxicity may be apparent. Because of the massive abdominal distention, the patient may have respiratory and cardiovascular compromise.

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