Volvulus

A twisting in the intestine with obstruction of the flow of material through the bowel, variable loss of blood supply, and possible tissue death.

Causes

It may be caused by the stomach being in the wrong position, a foreign substance, or an abnormal joining of one part of the stomach or intestine to another. It most commonly occurs in the sigmoid colon, the ileocecal area, or the small intestines.

Symptoms

Adults (sigmoid colon, 60%; cecal, 40%; small bowel, very rare):

• Severe, colicky abdominal pain
• Abdominal distention
• Recurrent episodes +++
• Constipation
• Nausea
• Vomiting

Signs

Adults:

• Diffuse abdominal tenderness
• Markedly tympanitic and distended abdomen
• Peritoneal signs, fever, and shock if ischemic

Treatment

Emergency surgery is requires to repair the volvulus. An incision is made in the abdomen, the bowels are inspected, and the volvulus is reduced. This means that the bowels are untwisted and the blood supply restored.

If a small segment of bowel is necrotic (dead from lack of blood flow), it is removed and the ends of the bowels sewn back together, or used to form a colostomy or ileostomy (tube to the outside through which bowel contents can be removed -- the term depends on where the tube is formed). If the entire bowel is necrotic, the outlook is poor, and the situation may be fatal.