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Volvulus

What is a volvulus?

A volvulus occurs when part of the colon or intestine twists. The twisting causes bowel obstructions that may cut off the blood supply to areas of the bowels.

A volvulus is a medical emergency that needs surgical treatment. If left untreated, the parts of the bowels that are not receiving enough blood will start to die.

Volvulus of the small intestine usually occurs in infants and children. In adults, volvulus of the small intestine is rare.

In adults, volvulus tends to occur in the colon and is known as a sigmoid volvulus.

Causes

In infants, volvulus of the small intestine often occurs due to malrotation. Malrotation occurs when a problem with the way the intestines form causes them to settle in the wrong place in the abdomen. This can cause the intestines to twist or become blocked.

In adults, causes of a sigmoid volvulus include:

  • an enlarged colon
  • abdominal adhesions that develop after surgery, injury, or infection
  • diseases of the large intestine, such as Hirschsprung’s disease
  • a colon that is not attached to the abdominal wall
  • a narrow connection at the base of the colon
  • chronic constipation
  • pregnancy

Additional risk factors for sigmoid volvulus include:

  • being male
  • being over 60
  • living in a nursing home or long-term care facility

Volvulus usually occurs due to another underlying condition or physical problem. However, it can sometimes occur on its own.

Symptoms

The symptoms of volvulus appear suddenly and severely, so people usually go straight to the emergency room for prompt evaluation.

Symptoms of volvulus include the following:

  • abdominal pain and tenderness
  • vomiting green bile
  • nausea
  • distended abdomen
  • bloody stool
  • constipation
  • shock

Infants with volvulus may also exhibit additional signs and symptoms, including:

  • sudden bouts of crying
  • drawing in legs as if in pain
  • lethargy
  • rapid heart rate and breathing

Sometimes, a child may experience periods when they have volvulus symptoms and periods when they are symptom-free.

In these cases, the child may have intermittent volvulus, a form of the condition where the symptoms reoccur periodically but go away on their own.

Diagnosis

Prompt diagnosis of volvulus can help lead to successful treatment and better outcomes.

If a person shows signs of having a volvulus, a doctor will do a physical examination and ask the person about their medical history. They will usually order other tests, including:

  • blood tests
  • tests to examine stool for blood
  • barium X-rays for the upper or lower abdominal tract
  • computed tomography (CT) scans to check the abdomen for abnormalities
  • flexible sigmoidoscopy

Treatment

A volvulus needs prompt treatment and usually requires surgery. During surgery to correct a volvulus, a doctor will make a small incision in the abdominal wall near the site of the twisted part of the intestine and untwist it.

Afterward, the doctor will restore blood flow to the areas affected by the volvulus. If parts of the intestine have been without blood for too long and a portion of the intestine has died, the surgeon may remove that piece of the intestine.

Sometimes, a surgeon will have to remove so much of the intestine that it is impossible to reattach the ends to each other. If this happens, the surgeon may have to connect the two ends of the intestines to openings in the abdominal wall known as stomas.

If a person requires a stoma, stool will pass through these openings into a colostomy bag. This may be permanent or temporary.

Sometimes, this procedure leaves a person’s appendix in a different location. If this happens, a surgeon may remove the appendix, because if it were not in its proper place, a doctor might not be able to diagnose appendicitis in the future. Removing the appendix prevents this problem.

Complications

A volvulus must be treated as soon as possible to lessen the risk of complications.

Complications of a volvulus can include any of the following:

  • a severe infection of the blood called sepsis
  • a malabsorption disorder called short bowel syndrome, which results from the lack of small intestine
  • infection of the abdomen, known as secondary peritonitis

A volvulus can be life-threatening if not treated promptly.

Outlook

The outlook for volvulus varies and depends largely on the speed of treatment. Early diagnosis and treatment of volvulus can help prevent serious complications.

However, in instances where a volvulus has lead to tissue death in the bowel, the prognosis may be poor.

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