Volvulus of the intestine and adjoining mesentery

Volvulus of the intestine and adjoining mesentery

V olvulus can only be understood if considered in mesenteric terms. Where a section of intestine is curved, the adjoining mesentery is buckle-shaped or folded. If the intestine progresses from a curve to a coil, the adjoining mesentery acquires a spiral shape. The resultant coil/spiral complex of the intestine and mesentery is termed a volvulus. Its formation is normally prevented by adhesion of the mesentery to the posterior abdominal wall during development. Wherever mesenteric adhesion is inadequate, there is a risk of volvulus formation. Sigmoid volvulus is the commonest type, followed by ileocaecal. However, the anatomy of the mesentery is such that volvulus can theoretically arise at any level from the oesophagogastric to anorectal junction.

Normal intestinal conformation Malrotation Intestine aligned Intestine non-aligned Figure 65.13 Malrotation. (Reproduced with permission from Coffey JC, Lavery I, surgery: basic and applied principles . Boca Raton: CRC Press, 2017: 85–108.)