Volvulus: definition, causes and treatment

Volvulus is the twisting of a section of the large or small intestine (gut). It is a serious disease that can lead to bowel obstruction and other complications.

Volvulus can be due to differences in anatomy, such as birth defects. Other medical conditions, such as long-term constipation, can make volvulus more likely.

The volvulus can cause severe pain and cut off the blood supply to the downstream part of the intestine. Doctors may use specific types of endoscopy to untangle it or perform surgery to remove the twisted part of the intestine.

The stomach can also develop a volvulus.

This article will focus on the causes, types, diagnosis, and treatment of volvulus.

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Volvulus occurs when a loop of intestine has twisted on itself at a point along the gastrointestinal (GI) tract. It can affect any part of the intestine, but it usually affects the large intestine or colon.

Your intestines are muscular tubes that digest and propel food and its waste products (stool) through the rectum and out of the body. Various conditions can affect the muscles and other aspects of the intestine. This can lead to loose or extra bowels that are more likely to buckle and twist. You can be born with a bowel disease or acquire it as you age.

Volvulus can lead to bowel obstruction. This means that the intestinal contents cannot pass through and can cause a hole in the intestinal wall. The volvulus can also reduce or stop blood flow to the tissues. This causes serious damage. A bowel obstruction is a medical emergency.

Rarely, volvulus involves the stomach. This is a very serious condition known as gastric volvulus.

Volvulus and its symptoms can come on slowly or suddenly. The volvulus traps the intestinal contents (gas and stools), enlarging.

Contact a doctor immediately for the following cases volvulus symptoms or its complications. Symptoms may include:

Sometimes volvulus is a medical emergency. Dial 911 for:

  • bloated stomach
  • persistent vomiting
  • severe abdominal pain
  • shock symptoms:
    • change in level of consciousness
    • rapid heart rate
    • pale skin
    • sweat

What are the types of volvulus?

The main types of intestinal volvulus are the midgut and the colon. Gastric volvulus is a rare type of volvulus.

The midgut begins in the small intestine and extends to the middle of the colon. Midgut volvulus is a spiral-shaped twist of the intestine. Another name for mid-bowel volvulus is small-bowel volvulus.

Intestinal malrotation is the main cause. This is a birth defect where the intestines are in a different position.

Midgut volvulus most of the time occurs in the first year of life, but can occur in older people. It is a life-threatening condition that requires emergency surgery.

Sigmoid and caecal volvulus are the two most common types of colonic volvulus, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The sigmoid colon is approximately the last third of the colon, before the rectum. Sigmoid volvulus is more common in older men who:

  • have a chronic illness or disease of the nervous system
  • reside in a nursing home or mental institution

The cecum is the last part of the small intestine and the beginning of the large intestine on the right side of the body. Cecal volvulus is more common in women between 20–30 year.

Causes of colonic volvulus may involve structural differences that allow the intestines to move more than usual. Factors that make colonic volvulus more likely to understand:

  • high fiber diet
  • chronic constipation
  • frequent use of laxatives
  • abdominal adhesions, which are bands of scar tissue from previous surgery
  • Hirschsprung’s disease, a birth defect that blocks the movement of stool through the colon
  • Chagas disease, a parasitic infection that can enlarge the colon

Gastric volvulus occurs when the stomach twists more than 180° on itself, causing an obstruction. It can occur in children and adults.

Some causes of gastric volvulus to understand:

  • wound
  • hiatal hernia
  • paralysis of the phrenic nerve, which controls your diaphragm
  • abdominal adhesions
  • structural abnormalities

People with gastric volvulus may have three signs and symptoms called Borchardt’s triad:

  • sudden and severe abdominal pain
  • uncontrollable vomiting sounds without actually vomiting
  • inability to guide a nasogastric tube (from the nose to the intestine)

How is volvulus diagnosed?

Your doctor will perform a physical exam, feel your abdomen, and ask you questions about your medical history and potential risk factors. They will also use a stethoscope to listen to your abdomen for movement sounds.

Tests may include:

Treatment depends on the specific type of volvulus but usually involves surgery. The goal of treatment is to untangle the volvulus, minimize complications, and prevent it from recurring. Sometimes the surgeon has to remove part of the intestine.

Midgut volvulus requires surgery. The surgeon untangles the bowel to clear the obstruction. Watchful observation continues in case she twists again. The surgeon will need to remove any damaged tissue.

If there is no damage to the colon, the doctor may attempt to untangle the volvulus using flexible sigmoidoscopy. This procedure involves inserting a lighted tube through the rectum to the volvulus.

The surgeon may need to remove the area after untwisting it. Partial colectomy or bowel resection are clinical terms for the procedure. The doctor reconnects the new ends of the intestine or creates a colostomy.

Intestinal resection is absolutely necessary in case of colon injury.

Cecal volvulus requires surgery. Studies indicate that processing time should be within 24-72 diagnostic hours. The surgeon performs a partial colectomy and reattaches the new ends. sometimesinstead of colectomy, they can untwist the cecum and secure it to the abdominal wall to prevent future volvulus.

Read What to expect after a colectomy.

Surgery is needed to treat gastric volvulus. The goal is to save the stomach and prevent recurrences while stabilizing the underlying cause.

Many factors affect the long-term outlook after volvulus treatment. Possible complications include:

Prompt diagnosis and treatment of volvulus can save lives and prevent complications.

The recurrence rate of colonic volvulus can reach 40–60% for non-surgical treatment (sigmoidoscopy), surgery may therefore be a better long-term treatment. Mortality rates appear to be higher for cecal volvulus than for sigmoid volvulus.

Other Frequently Asked Questions

Saurabh Sethi, MD, has reviewed the following frequently asked questions.

What is the most common type of volvulus?

The The most common type of volvulus in adults is sigmoid volvulus. The most common type in children is midgut volvulus or small bowel volvulus.

Who is at risk of developing a volvulus?

The volvulus is The most common in adults aged 50 to 80. The following factors increase the risk of volvulus:

  • chronic constipation
  • chronic medical condition
  • chronic nervous system disorder
  • residency in a long-term care facility

Can the volvulus resolve on its own?

Isolated case studies indicate that a cecal volvulus has the potential to resolve without treatment, but this is often not the case. The surgery is in general the first-line treatment for volvulus, according to the NIDDK.

Volvulus occurs when part of the intestine or stomach twists on itself and causes an obstruction. Volvulus is a very painful and potentially life-threatening gastrointestinal condition. The causes and risk factors for volvulus depend on the type. Prompt diagnosis and treatment increase the chances of a positive outcome and minimize the risk of serious complications.

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