Table of ContentsDefinition / general | Essential features | Terminology | Sites | Etiology | Clinical features | Radiology description | Radiology images | Case reports | Treatment | Gross description | Microscopic (histologic) description | Sample pathology report | Additional references | Board review style question #1 | Board review style answer #1
Cite this page: Gonzalez RS. Volvulus. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonvolvulus.html. Accessed April 15th, 2021.
Definition / general
- Complete twisting of loop of bowel around its mesenteric base of attachment, causing obstruction and infarction
- Clinical torsion of colon leading to colonic necrosis
- High mortality rate
- Also called torsion (volvulus is a more specific term referring to gastrointestinal torsion)
- Usually involves cecum or sigmoid (Can J Surg 2006;49:203)
- Potentially due to adhesions from prior surgery
- More common in men
- Patients typically demonstrate abdominal pain, distension, hyperactive bowel sounds
- High rate of mortality, particularly in older patients (Eur Rev Med Pharmacol Sci 2013;17:127)
- Dilated loops of intestine
- Volvulus may be visible on CT
- 16 year old boy with sigmoid volvulus with an associated anomalous congenital band (Am Surg 2013;79:1140)
- Colonoscopy in uncomplicated patients (Tech Coloproctol 2013;17:561)
- Surgical exploration to untwist and resect gangrenous bowel
- Twisted, necrotic colon
- Gangrene may extend beyond constriction (Int J Colorectal Dis 2004;19:134)
Microscopic (histologic) description
- Colon may be ischemic or gangrenous
Sample pathology report
- Cecum and ascending colon, resection:
- Segment of colon with patchy transmural necrosis and serosal adhesions (see comment)
- Necrosis extends to distal resection margin; proximal margin unremarkable.
- Four benign lymph nodes.
- Comment: The findings are consistent with the clinical impression of volvulus as reported in the operative note.
Board review style question #1
Which of the following is true about volvulus of the colon?
- It can only be identified via surgical exploration
- It has a low rate of morbidity / mortality
- The affected colon appears normal microscopically
- The cecum is a common site