Splenic Flexure Volvulus
Splenic Flexure Volvulus
Andrew M. Holloway, MD and Michael T. Langford, MD
Table of Contents
Definition and Classification
Splenic Flexure Volvulus: Twisting of the Splenic Flexure of the Colon Around Itself
Causes a Closed Loop Obstruction That Can Cause Vascular Compromise with Ischemia, Necrosis, and Perforation
Numerous Ligamentous Fixed Attachments of the Splenic Flexure to the Stomach, Spleen, and Diaphragm Make Volvulus Particularly Rare (1-2%)
Classification
- Primary Sigmoid Flexure Volvulus: Associated with Congenital Abnormalities
- Laxity or Absence of Splenic Ligaments
- Congenital Bands
- Wandering Spleen
- Secondary Sigmoid Flexure Volvulus: Caused by Acquired Conditions
- Disruption of Ligaments
- Prior Surgical Mobilization of the Splenic Flexure
- Adhesions
Etiology
Congenital Risk Factors
- Laxity or Absence of Splenic Ligaments
- Congenital Bands
- Wandering Spleen
Secondary Risk Factors
- Prior Surgical Mobilization of the Splenic Flexure
- Disruption of Ligaments
- Adhesions
- Chronic Constipation
- High-Fiber Diet
- Colonic Dysmotility
- Pregnancy
- Inflammatory Conditions (Inflammatory Bowel Disease or Chagas Disease)
Presentation and Diagnosis
Presentation
- Abdominal Pain
- Abdominal Distention
- Nausea and Vomiting
- Obstipation
Diagnosis
- Generally Diagnosed by CT Abdomen/Pelvis
- Splenic Flexure is Dilated and Twisted
- “Whirl Sign” with Mesentery Twisted
- Abdominal Plain Film is Generally Nondiagnostic
Can Be Diagnosed at Surgical Exploration in an Emergent Setting
Management
The Primary Treatment is Surgical Resection
- Generally Requires a More Extensive Resection with Ileosigmoid or Ileorectal Anastomosis
Endoscopic Detorsion Not Recommended