Colonic Volvulus at the Splenic Flexure

Features of a volvulus:

(1) axial twist of the intestine along its mesentery

(2) luminal obstruction

(3) vascular compromise

Normally the splenic flexure is relatively immobile due to the phrenicocolic, gastrocolic and splenocolic ligaments.

Risk factors for a splenic flexure volvulus:

(1) congenital absence of the ligaments

(2) previous surgery with lysis of the ligaments

(3) malrotation

(4) band adhesions

(5) chronic constipation

Clinical features:

(1) abdominal pain

(2) absolute constipation

(3) large bowel obstruction

Complications:

(1) ischemia of the colon with gangrene

(2) rupture of the necrotic wall

(3) peritonitis

(4) sepsis