Volvulus

What is the term Volvulus

Volvulus is an abnormal twisting of a portion of the digestive tract. The digestive tract begins with the part of the body that moves food from your mouth to your stomach (esophagus). It also includes the stomach, small intestine, and large intestine. With volvulus, the twisting can block the flow of digestion (bowel obstruction). It can also block the flow of blood to the part of the digestive tract that is twisted. Lack of blood flow can cause the twisted part of the digestive tract to die. Volvulus is a medical emergency.

There are various types of volvulus:

  • Sigmoid volvulus is a twisting of the last part of the large intestine. This is the most common type.
  • Midgut volvulus usually occurs in children who are born with an abnormally positioned small intestine (malrotation).
  • Cecal volvulus may be caused by scar tissue from previous abdominal surgery.
  • Gastric volvulus is a rare type of volvulus that occurs when the stomach twists around itself.

What are the causes?

This condition may be caused by many different things. It can be something a person is born with (congenital deformity), or it may be a problem that develops from another condition.

What increases the risk?

You are more likely to develop this condition if you:

  • Are 50 years old or older.
  • Have long-term (chronic) constipation.
  • Have part of your stomach located above the area where the stomach and esophagus meet (paraesophageal hernia).
  • Are bedridden.
  • Have had previous abdominal surgery.
  • Live in a long-term care facility.

What are the signs or symptoms?

Symptoms of most types of volvulus include:

  • Abdominal pain.
    • Sigmoid volvulus may cause pain in the lower left part of the abdomen.
    • Cecal volvulus may cause pain in the lower right part of the abdomen.
    • Gastric and midgut volvulus may cause pain in the upper abdomen.
  • Bloating and swelling of the abdomen.
  • Decreased passing of gas or inability to pass gas.
  • Nausea.
  • Vomiting.
  • Constipation.
  • Tenderness when pressing on the abdomen.

As the condition gets worse, the volvulus can develop a hole (perforation) and leak digestive contents into the abdomen. This can cause late signs of volvulus, including:

  • Severe infection (sepsis).
  • Bleeding into the abdomen.
  • Very low blood pressure (shock).

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms. The health care provider may suspect volvulus if you have sudden symptoms of intestinal obstruction.
  • A physical exam. During the exam, the health care provider will listen to your abdomen for the sounds of digestion and will feel your abdomen for tenderness.
  • Imaging studies of your abdomen, such as:
    • CT scan. This is the best imaging study for diagnosing volvulus.
    • Plain X-rays. These may show air and fluid levels and widening above the obstruction.
    • Ultrasound.

How is this treated?

This condition is almost always a medical emergency that requires surgery right away. Options include:

  • Emergency colonoscopy. A lubricated, flexible tube that has a camera on the end of it is inserted into the anus and then passed into the rectum, colon, and other parts of the large intestine. If your volvulus is in the large intestine, this procedure may be an option for untwisting it.
  • An abdominal surgery to untwist the volvulus.
  • If your volvulus cannot be untwisted, you may need to have part of the digestive tract removed (resection).

Follow these instructions at home:

  • Follow instructions from your health care provider about recovery after your procedure.
  • Get plenty of rest.
  • Follow instructions about eating restrictions. You may need to avoid solid foods and consume only clear liquids until your condition improves.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Get help right away if:

  • You have increased pain or cramping.
  • You have a fever.
  • Your abdomen is swollen.
  • You have nausea or vomiting.
  • You have blood in your stool or vomit.

Summary

  • Volvulus is an abnormal twisting of a portion of the digestive tract.
  • Lack of blood flow can cause the twisted part of the digestive tract to die.
  • Intense abdominal pain, nausea, vomiting, and an inability to pass gas are symptoms of volvulus.
  • Volvulus is a medical emergency. It usually requires surgery right away.
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