What is an intestinal volvulus?

An intestinal volvulus is a twisting of the intestine on itselfincluding the mesentery (part of the peritoneum that joins the intestine to the posterior abdominal wall), and which causes intestinal obstruction. They can also affect the stomach (gastric volvulus).

Symptoms can come on quickly or progressively, but they almost always include abdominal pain and swelling, vomiting, constipation, and bloody stools. The blood supply of the intestine comes through the mesentery, and its torsion can reach cut blood risk to the affected area of ​​the intestine (intestinal ischemia), a situation that is usually accompanied by fever and severe pain when palpating the abdomen.

Progression of the volvulus and lack of blood flow can lead to major complications, including fecal peritonitis, perforation, gangrene due to necrosis, acidosis, and ultimately death in extreme cases. Acute volvulus usually requires urgent surgery to undo intestinal torsion and, if necessary, to remove the portion of the intestine that has become necrotic.

Causes and types

Volvulus can be classified into several types depending on the part of the digestive system where they occur:

  • gastric volvulus: the stomach undergoes torsion on itself and its mesentery. There are cases of gastric rotation that do not cause intestinal obstruction, in which case it is not considered a volvulus.
  • middle volvulus: affects the small intestine.
  • caecal volvulus: affects the intestinal cecum.
  • sigmoid volvulus: affects the sigmoid colon.
  • others: transverse colon volvulus, splenic flexure volvulus, sigmoid ileus volvulus, etc.

Most cases of intestinal volvulus affect middle aged men. By type, sigmoid volvulus are the most common and are responsible for 8% of all cases of intestinal obstruction. Sigmoid volvulus are especially common in elderly patients with constipation.

Medium volvulus primarily affects neonates who present with congenital rotation of the intestine. Although they can occur at any age, about 80% of cases are in infants.

Pregnancy increases the risk of volvulus in women, due to the movement and pressure that the fetus exerts on the digestive tract.

Some diseases increase the risk of volvulus developing secondarily. For example, redundant colon and Duchenne muscular dystrophy.

In either type, the differential diagnosis is frequently made with X-ray radiographs and other imaging techniques such as computed tomography. The differential diagnosis should always be made in cases of intestinal obstruction to rule out other diseases such as ulcerative colitis, Crohn's disease or other more serious ones, for example obstructive carcinomas.

Treatment

Treatment of volvulus depends on its exact location and condition, but surgical intervention to undo the torsion is usually the most common treatment.

In the treatment of sigmoid volvulus, it is usual to perform a sigmoidoscopy (a type of intestinal endoscopy) to visualize the conditions of the volvulus. If the mucosa appears normal, without signs of necrosis, a tube is placed that corrects the obstruction temporarily until the surgical intervention is performed. If the intervention is not performed, the chances of recurrence are high.

Surgical intervention may include resection of the part of the intestine that is necresed. If there are signs of infection, perforation, or other serious complications, surgery may be urgent.

Some types of volvulus can be placed in the correct position through laparotomy, especially cecal and rectal volvulus without necrosis.

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