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GROUP 6
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DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
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DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
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• Volvulus is a condition that arises when the
intestines twist abnormally due to improper
fixation to the abdominal wall. This
inadequate anchoring permits abnormal
rotation of the intestines, which can
obstruct the passage of intestinal contents
and compromise blood flow.
DEFINITION
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• Volvulus is frequently
associated with intestinal
malrotation, a congenital
anomaly characterized by
incomplete or incorrect
rotation and fixation of the
intestines within the
abdominal cavity during fetal
development.

DEFINITION
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DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
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DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
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PATHOPHYSIOLOGY
Bowel Loop Twists Around Its Mesentery

Closed-Loop Obstruction Develops

Impaired Blood Flow —> Ischemia

Intestinal Wall Damage —> Inflammation, Edema, Necrosis

Possible Perforation (Bowel wall rupture)

Bacterial Translocation —> Risk of Sepsis

Severity Depends on Duration and Degree of Torsion

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DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
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DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
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ASSESSMENT
HISTORY TAKING:
• Sudden onset of abdominal pain (crampy or severe)
• History of constipation or abdominal distension
• Previous episodes of similar symptoms
• Risk factors (e.g., chronic constipation, prior
abdominal surgeries)
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ASSESSMENT
PHYSICAL EXAMINATION:
• Inspection: Distended abdomen, visible peristalsis (late
sign)
•Palpation: Tenderness, guarding, rebound tenderness if
perforation/ischemia
•Percussion: Tympanic abdomen (due to trapped gas)
•Auscultation: High-pitched bowel sounds (early) or absent
sounds (late or ischemic phase)
•Signs of peritonitis (rigid abdomen) if advanced.
 ADDITIONAL POINTS FOR ASSESSMENT
Age
• Infants: Midgut volvulus is common and life-threatening.
• Adults: Sigmoid volvulus is more common, especially in
elderly or psychiatric patients with chronic constipation.
Speed of symptom progression
• Faster symptom progression suggests ischemia and a
surgical emergency.
Hydration status
• Assess for dehydration from vomiting or third-spacing.

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DIAGNOSTIC
• Abdominal X-ray: Shows “coffee-bean” sign
(especially in sigmoid volvulus)
• CT Scan: Most sensitive; shows “whirl sign”
(twisted bowel loops)
• Contrast enema: “Bird’s beak” appearance
(sigmoid volvulus)
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DIAGNOSTIC
• Abdominal X-ray: Shows “coffee-bean” sign
(especially in sigmoid volvulus)
• CT Scan: Most sensitive; shows “whirl sign”
(twisted bowel loops)
• Contrast enema: “Bird’s beak” appearance
(sigmoid volvulus)
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SIGNS AND SYMPTOMS
• Sudden onset abdominal cramping
• Abdominal distention
• Nausea and vomiting (may be feculent)
• Constipation or inability to pass flatus
• Dehydration signs (dry mucosa, hypotension)
• Fever (if ischemia or perforation develops)
• Shock signs (tachycardia, hypotension) if untreated
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COMPLICATIONS
• Bowel ischemia (lack of blood supply)
• Bowel necrosis (tissue death)
• Perforation (rupture of the bowel wall)
• Sepsis (systemic infection)
• Peritonitis (infection of the abdominal cavity)
• Death (if not treated promptly)
 RISK FACTORS:
• Chronic constipation (especially elderly patients)
• Congenital malformations (in infants, like malrotation)
• Previous abdominal surgery (adhesions)
• High-fiber diet (can cause a loaded colon, esp. in
sigmoid volvulus).
• Pregnancy (due to displacement of intestines)
• Neurologic conditions (like Parkinson’s disease) causing
bowel dysmotility
• Elderly age (decreased intestinal motility)

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DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
 Vo l vu lus
DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
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MANAGEMENT
MEDICAL MANAGEMENT
• Antibiotics: Broad-spectrum antibiotics are
administered to prevent infection such as
1. CLINDAMYCIN
2. METRONIDAZOLE
3. CEFOXITIN
4. CEFOTETAN
5. IMIPENEM/CILASTATIN
6. MEROPENEM
7. PIPERACILLIN-TAZOBACTAM
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MANAGEMENT
MEDICAL MANAGEMENT
• Commonly used pain medications include morphine
sulfate and hydromorphone.
• Commonly used antiemitics include promethazine and
ondansetron.
• Surgery: first line of treatment for volvulus
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MANAGEMENT
MEDICAL MANAGEMENT

• Rehydration and Electrolyte Correction: All patients

presenting with a sigmoid volvulus are often
intravascularly fluid deplete therefore need aggressive
fluid resuscitation.
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MANAGEMENT
MEDICAL MANAGEMENT

• Nasogastric Decompression and Urinary

Catheterization: Ensure a nasogastric tube is placed,
especially if the patient is vomiting, and a urinary
catheter is inserted for fluid balance assessment.
Adequate analgesia should be prescribed and ensure
any electrolyte abnormalities are corrected.
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MANAGEMENT
CONSERVATIVE MANAGEMENT
• Sigmoidoscopy decompression: Most
patients with sigmoid volvulus are
treated conservatively initially with
decompression by sigmoidoscope
and insertion of a flatus tube.

• In a significant proportion of patients,

decompression with a rigid
sigmoidoscope cannot be
successfully achieved and a formal
flexible sigmoidoscopy is required.
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MANAGEMENT
SURGICAL MANAGEMENT
1. Emergency surgery is required for patients with a
sigmoid volvulus in those with any evidence of bowel
ischemia or perforation (or in those with repeat failed
endoscopic decompression).
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MANAGEMENT
SURGICAL MANAGEMENT
2. Sigmoid Colectomy: Removal of the affected segment
with primary anastomosis if conditions allow.
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MANAGEMENT
SURGICAL MANAGEMENT
• Patients with recurrent volvulus may choose to have an
elective procedure, either as a sigmoid colectomy with
primary anastomosis or end colostomy, to prevent
further recurrence. The risks of recurrence need to be
balanced against the risks of surgery, especially in this
often frail and co-morbid patient group.
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MANAGEMENT

SURGICAL MANAGEMENT

3. Hartmann Procedure: Used when

the patient is unstable or there is
significant contamination. In this
procedure, the diseased bowel
segment is resected, the proximal
end is brought out as a colostomy,
and the distal stump is closed.
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MANAGEMENT

SURGICAL MANAGEMENT

4. Right Hemicolectomy: For cecal

volvulus, a right hemicolectomy
(removal of the right side of the
colon) is often performed.
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MANAGEMENT

SURGICAL MANAGEMENT

5. Ladd Procedure: In cases of

malrotation with volvulus (a
condition where the intestines are
not in their normal position), a Ladd
procedure is performed to correct
the malrotation and reduce the risk
of future volvulus.
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MANAGEMENT

SURGICAL MANAGEMENT

6. Stoma Creation: If resection

is necessary, a stoma (opening
in the abdomen) may be created
to allow waste to exit the body.
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MANAGEMENT

SURGICAL MANAGEMENT

7. Laparoscopy: Laparoscopic surgery is a minimally invasive

approach that can be used for certain types of volvulus,
offering potential benefits like shorter hospital stays and less
blood loss.
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MANAGEMENT
SURGICAL MANAGEMENT
1. Emergency Surgery – Required in cases with bowel ischemia, perforation, or failed endoscopic
decompression.
2. Sigmoid Colectomy – Involves removal of the twisted sigmoid colon segment with reattachment
(primary anastomosis) if conditions allow. May be elective in recurrent cases.
3. Hartmann Procedure – Performed in unstable patients or with contamination. The affected
segment is resected, the proximal end is made into a colostomy, and the distal stump is closed.
4. Right Hemicolectomy – Surgical removal of the right colon, commonly done in cases of cecal
volvulus.
5. Ladd Procedure – Performed in infants with malrotation with volvulus to untwist the bowel and
correct abnormal positioning to prevent recurrence.
6. Stoma Creation – A stoma may be created when resection is needed, allowing waste to exit
through an opening in the abdomen.
7. Laparoscopy – A minimally invasive surgical option that may be suitable for certain volvulus
cases, offering quicker recovery and less postoperative pain.
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MANAGEMENT
Post-Surgical Care:
• Postoperative management includes close monitoring for
complications like infection, sepsis, or anastomotic leaks.
• Nutritional support and gradual reintroduction of oral
intake are also essential.
 Vo l vu lus
DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
 Vo l vu lus
DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
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NURSING RESPONSIBILITIES

Early Recognition and Continuous Monitoring

• Assess for signs of volvulus
• Monitor vital signs closely
• Perform abdominal assessments regularly

Gastrointestinal Decompression and Support

• Insert and manage a nasogastric tube
• Keep infant NPO
• Document NG output
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NURSING RESPONSIBILITIES
Fluid and Electrolyte Management
• Initiate IV therapy
• Monitor input and output closely
• Correct electrolyte abnormalities

Infection Control
• Administer prescribed antibiotics
• Maintain strict aseptic technique
• Observe for signs of infection
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NURSING RESPONSIBILITIES
Surgical Preparation and Postoperative Care
• Coordinate preoperative care
• Provide postoperative support
• Manage pain

Parental Support and Education

• Provide clear, compassionate communication
• Offer emotional support
• Encourage parental presence and involvement
• Educate parents on signs of recurrence or complications
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NURSING RESPONSIBILITIES

Interdisciplinary Collaboration
• Coordinate with the healthcare team
• Facilitate early follow-up planning
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DEFINITION
PATHOPHYSIOLOGY
ASSESSMENT AND DIAGNOSIS
MANAGEMENT
NURSING RESPONSIBILITIES
REFERENCES:
• Children’s Hospital. (n.d.). Ladd procedure for malrotation. Children’s Hospital. [Link]
• Cleveland Clinic. (n.d.). Hartmann’s procedure details. Cleveland Clinic. [Link]
• Cleveland Clinic. (n.d.). Intestinal malrotation & volvulus in children. Cleveland Clinic.
[Link]
• Coste, A. H., Anand, S., Nada, H., & Ahmad, H. (2022). Midgut volvulus. In StatPearls. StatPearls Publishing.
[Link]
• Hutson, J., et al. (Eds.). (2008). Jones Clinical Paediatric Surgery Diagnosis and Management (6th ed.). Blackwell
Publishing.
• Lange, M. (Ed.). (2023). Current medical diagnosis and treatment 2024 (63rd ed.). McGraw [Link], T. B., &
Rohrmann, C. A. (2017). Volvulus of the colon: Review of diagnosis and management. American Journal of Surgery,
213(2), 418–423. [Link]
• Longmore, M., Wilkinson, I., Baldwin, A., & Wallin, E. (2014). Oxford handbook of clinical diagnosis (4th ed.). Oxford
University [Link] Clinic. (2021). Volvulus. Mayo Clinic. [Link]
conditions/volvulus/symptoms-causes/syc-20301943
• Mayo Clinic. (n.d.). Bowel obstruction. Mayo Clinic. [Link]
obstruction
REFERENCES:
• Mayo Clinic. (n.d.). Sigmoid colectomy overview. Mayo Clinic. [Link] (n.d.). Sigmoid
volvulus and cecal volvulus. Medscape. [Link]
• Miller, A. G., & Shih, M. J. (2016). Sigmoid volvulus: A review. Clinical Colon and Rectal Surgery, 29(3), 157–163.
[Link]
• MSD Manual. (n.d.). Volvulus. MSD Manual. [Link]
disorders/intestinal-obstruction/volvulus
• Nationwide Children’s Hospital. (n.d.). Intestinal malrotation surgery. Nationwide Children’s.
[Link]
• Park, C. H., & Kim, D. S. (2021). Surgical management of sigmoid volvulus: Laparoscopic versus open surgery. Journal of
Gastrointestinal Surgery, 25(5), 1012–1020. [Link]
• Sarmiento, J. M., & Shatnawei, A. (2018). Volvulus of the small intestine. Surgical Clinics of North America, 98(4), 825–838.
[Link]
• Safer Care Victoria. (n.d.). Bowel obstruction in neonates. Safer Care Victoria. [Link]
practice-improvement/clinical-guidance/neonatal/bowel-obstruction-in-neonates
• Sydney Children’s Hospitals Network. (2025). Ladd’s procedure for malrotation and volvulus factsheet. Sydney Children’s
Hospitals Network. [Link]