Tutorial Klinik

Volvulus
 Volvulus adalah puntiran dari segmen usus
terhadap usus itu sendiri, mengelilingi
mesenterium dari usus tersebut dimana
mesenterium itu sebagai aksis longitudinal
sehingga menyebabkan obstruksi saluran
cerna.
 Volvulus banyak menyerang usia neonatus
68-71%. Infant dengan malrotasi, sebanyak
40% bermanifestasi klinis saat minggu
pertama kelahiran, 50% pada bulan
pertama, sisanya bermanifestasi lebih dari 1
bulan.
 Gastric volvulus Midgut volvulus Colonic volvulus

Mesentero-
Organo-axial axial Sigmoid Cecal

Organo- Mesentero-
axial axial Axial Bascule
 Gastric volvulus Midgut volvulus Sigmoid volvulus Cecal volvulus
1ry: Malrotation (short Congenital defect
Congenital mesenteric in the peritoneal
weakness of attachment). fixation of the right
suspensory colon.
ligaments. Congenital short
mesentery. Congenital long
2ry: mesentery.
Diaphragmatic
hernia. Congenital
Diaphragmatic malrotation.
eventration
Chronic Chronic
constipation. constipation.

Colonic distention. Colonic distension.

 C.P
Gastric volvulus Midgut volvulus Sigmoid volvulus Cecal volvulus
Acute volvulus: •Neonatal intestinal •Acute intestinal •Acute intestinal
Borchardt triad: obstruction. obstruction. obstruction.
1. Sever •Bilious vomiting.
epigastric pain. •Abdominal
2. Violent distension.
retching
without
vomiting.
3. Difficulty in
advancing in
nasogastric
tube.

Chronic volvulus:
Vague non specific
symptoms.
Gastric volvulus Midgut volvulus Colonic volvulus

Intrathoracic
Double
stomach with Sigmoid Cecal
bubble sign
air fluid level

Coffe bean Marked cecal

sign distension
• Intra-thoracic stomach with double air fluid level.
• Intrathoracic stomach with double air fluid level.
• Double bubble sign.
A volvulus always extends away from the area of bowel twist.
Sigmoid volvulus Cecal volvulus
sigmoid volvulus can only move upwards Cecal volvulus however can go almost
and usually goes to the right upper anywhere and can even be located in the
quadrant. pelvis.
 Sigmoid volvulus Cecal volvulus
Associated with large bowel dilatation. Associated with small bowel dilatation.
 Gastric volvulus Midgut volvulus Colonic volvulus

Organo- Mesentero Cork scerw Sigmoid

duodenum Cecal
axial -axial

Greater Gastric antrum

curvature above above gastric Beak sign Beak sign
lesser curvature fundus
• Cork screw duodenum & proximal jejunum.
• Cork screw duodenum & proximal jejunum.

S
D
S

R
A