Volvulus physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Patients with volvulus usually appear in distress. Vital signs may demonstrate tachycardia and low grade fever. Physical examination of patients with volvulus is usually remarkable for abdominal distention and abdominal tenderness.
Physical Examination
Appearance of the Patient
Patients with volvulus usually appear in distress.[1][2][3]
Vital Signs
- Low-grade fever
- Tachycardia with regular pulse
- Tachypnea
- Low blood pressure with narrow pulse pressure, in the case of hypovolemic shock with bowel perforation
Lungs
In the case of gastric volvulus when the stomach may be displaced into the chest cavity, the patient may present with stridor.
Heart
- Orthostatic hypotension may be present
- Severe distension may lead to cardiogenic shock.
Abdomen
- Abdominal distention and tympany
- May be severe and cause cardiovascular and respiratory symptoms
- Abdominal tenderness
- May indicate peritonitis
- Rebound tenderness (positive Blumberg sign)
- May indicate peritonitis
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Empty left iliac fossa
- May indicate sigmoid volvulus
- May indicate sigmoid volvulus
References
- ↑ "Retraction. Clinical presentation and diagnosis of sigmoid volvulus: outcomes of 40-year and 859-patient experience". J. Gastroenterol. Hepatol. 24 (6): 1154. 2009. doi:10.1111/j.1440-1746.2007.04946.x. PMID 17524041.
- ↑ Avots-Avotins KV, Waugh DE (1982). "Colon volvulus and the geriatric patient". Surg. Clin. North Am. 62 (2): 249–60. PMID 7071692.
- ↑ Raveenthiran V (2000). "Emptiness of the left iliac fossa: a new clinical sign of sigmoid volvulus". Postgrad Med J. 76 (900): 638–41. PMC 1741756. PMID 11009578.