2143
Occurs when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction.
Frequency 2.5 per 100,000 per year.
Associated symptoms include: abdominal pain, bloating, vomiting, constipation, and bloody stool.
Onset of symptoms may be rapid or gradual.
Volvulus accounts for 10 to 15% of large bowel obstructions.
Sigmoid volvulus is more common than ccal volvulus.
If the mesentery is so tightly twisted the blood flow may be compromised, resulting in ischemic bowel.
Risk factors include: Intestinal malrotation, enlarged colon, Hirschsprung disease, pregnancy, abdominal adhesions, chronic constipation, and a high fiber diet.
Most commonly affected part of the intestines in adults is the sigmoid colon with the cecum being second most affected.
In children the small intestine is most often involved.
Occasionally the stomach can also be affected.
Diagnosis is typically made with with medical imaging such as plain X-rays, a GI series, or CT scan.
Initial treatment for a sigmoid volvulus may occasionally occur via sigmoidoscopy or with a barium enema, with resolution of the process.
However, due to the high risk of recurrence, a bowel resection is generally recommended.
Immediate surgery is required if there is the bowel is severely twisted or the blood supply is compromised.
In a cecal volvulus, that part of the bowel usually needs to be surgically removed.
It occurs most frequently in Africa, the Middle East, and India, while rates in the United States are about 2–3 per 100,000 people per year.
Sigmoid and cecal volvulus typically manifest between the ages of 30 and 70.
Regardless of cause, volvulus causes symptoms by two mechanisms:
Bowel obstruction manifested as abdominal distension and bilious vomiting.
Ischemia to the affected portion of intestine.
Symptoms vary with the location of the volvulus.
With a cecal volvulus, the predominant symptoms may be those of a small bowel obstruction because the obstructing point is close to the ileocecal valve and small intestine.
With a sigmoid volvulus, abdominal pain may be present, but symptoms of constipation may be more prominent.
It causes pain, and injury to the intestinal wall, with accumulation of gas and fluid in the portion of the bowel obstructed.
It can result in necrosis of the affected intestinal wall, with acidosis, and death.
This bowel obstruction is a closed loop one, because there exists an isolated closed loop of bowel.
Often requires immediate surgical intervention to untwist the affected segment of bowel and possibly resect any unsalvageable portion.
It occurs most frequently in middle-aged and elderly men.
Can also arise in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops.
Sigmoid volvulus is the most-common form of volvulus of the gastrointestinal tract.
Sigmoid volvulus is responsible for 8% of all intestinal obstructions.
Sigmoid volvulus is common in elderly persons and constipated patients.
Volvulus patients experience abdominal pain, distension, and absolute constipation.
Cecal volvulus has slightly less common occurrence rate than sigmoid volvulus.
Cecal volvulus is associated with symptoms of abdominal pain and small bowel obstruction.
Volvulus can also occur in patients with Duchenne muscular dystrophy due to the smooth muscle dysfunction.
Midgut volvulus occurs usually in babies that are predisposed because of congenital intestinal malrotation.
Segmental volvulus occurs in people of any age, usually with a predisposition because of abnormal intestinal contents or adhesions.
Volvulus of the cecum, transverse colon, or sigmoid colon occurs, usually in adults, with only minor predisposing factors such as redundant intestinal tissue and constipation.
Types of volvulus
volvulus neonatorum
volvulus of the small intestine
volvulus of the caecum
sigmoid volvulus
volvulus of the transverse colon
volvulus of the splenic flexure,
gastric volvulus
ileosigmoid knot
Abdominal plain x-rays are commonly confirmatory for a volvulus, especially if a “bent inner tube” sign or a “coffee bean” sign are seen referring to the shape of the air filled closed loop of colon which forms the volvulus.
A barium enema may be used to demonstrate a “bird’s beak” at the point where the segment of proximal bowel and distal bowel rotate to form the volvulus.
The differential diagnosis includes the much more common constricting or obstructing carcinoma, occurring in approximately 80 percent of colonic obstructions.
Diverticulitis
Ulcerative colitis or Crohn’s disease may cause colonic obstruction.
Chronic constipation and impaction may cause a pseudo obstruction.
Treatment for sigmoid volvulus is surgical repair.
In a cecal volvulus, the cecum may be returned to a normal position and sutured in place, a procedure known as cecopexy.