Volvulus

Volvulus
Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock
SpecialtyGeneral surgery
SymptomsAbdominal pain, abdominal bloating, vomiting, constipation, bloody stool[1][2]
ComplicationsIschemic bowel[1]
Usual onsetRapid or more gradual[2]
Risk factorsIntestinal malrotation, enlarged colon, Hirschsprung disease, pregnancy, abdominal adhesions, chronic constipation[1][3]
Diagnostic methodMedical imaging (plain X-rays, GI series, CT scan)[1]
TreatmentSigmoidoscopy, barium enema, bowel resection[3]
Frequency2.5 per 100,000 per year[4][2]

A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction.[1] Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool.[1][2] Onset of symptoms may be rapid or more gradual.[2] The mesentery may become so tightly twisted that blood flow to part of the intestine is cut off, resulting in ischemic bowel.[1] In this situation there may be fever or significant pain when the abdomen is touched.[2]

Risk factors include a birth defect known as intestinal malrotation, an enlarged colon, Hirschsprung disease, pregnancy, and abdominal adhesions.[1] Long term constipation and a high fiber diet may also increase the risk.[3] The most commonly affected part of the intestines in adults is the sigmoid colon with the cecum being second most affected.[1] In children the small intestine is more often involved.[5] The stomach can also be affected.[6] Diagnosis is typically with medical imaging such as plain X-rays, a GI series, or CT scan.[1]

Initial treatment for sigmoid volvulus may occasionally occur via sigmoidoscopy or with a barium enema.[3] Due to the high risk of recurrence, a bowel resection within the next two days is generally recommended.[3] If the bowel is severely twisted or the blood supply is cut off, immediate surgery is required.[1] In a cecal volvulus, often part of the bowel needs to be surgically removed.[3] If the cecum is still healthy, it may occasionally be returned to a normal position and sutured in place.[1][3]

Cases of volvulus were described in ancient Egypt as early as 1550 BC.[3] It occurs most frequently in Africa, the Middle East, and India.[3][7][8] Rates of volvulus in the United States are about 2–3 per 100,000 people per year.[2][4] Sigmoid and cecal volvulus typically occurs between the ages of 30 and 70.[1][9] Outcomes are related to whether or not the bowel tissue has died.[2] The term volvulus is from the Latin "volvere"; which means "to roll".[3]

  1. ^ a b c d e f g h i j k l m "Anatomic Problems of the Lower GI Tract". NIDDK. July 2013. Archived from the original on 28 July 2016. Retrieved 3 August 2016.
  2. ^ a b c d e f g h Marx J, Walls R, Hockberger R (2013). "95". Rosen's Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences. ISBN 978-1-4557-4987-4. Archived from the original on 2016-08-16.
  3. ^ a b c d e f g h i j Gingold D, Murrell Z (December 2012). "Management of colonic volvulus". Clinics in Colon and Rectal Surgery. 25 (4): 236–44. doi:10.1055/s-0032-1329535. PMC 3577612. PMID 24294126. The Papyrus Ebers, ca. 1550 BC, described the natural course of volvulus to be spontaneous reduction or "rotting" of the intestines
  4. ^ a b Gordon PH, Nivatvongs S (2007). Principles and Practice of Surgery for the Colon, Rectum, and Anus, Third Edition. CRC Press. p. 971. ISBN 978-1-4200-1799-1. Archived from the original on 2016-08-17.
  5. ^ Wilkins LW (2009). Professional Guide to Diseases. Lippincott Williams & Wilkins. p. 283. ISBN 978-0-7817-7899-2.
  6. ^ Feldman M, Friedman LS, Brandt LJ (2010). Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features (9 ed.). Elsevier Health Sciences. p. 384. ISBN 978-1-4377-2767-8. Archived from the original on 2016-08-16.
  7. ^ Brothwell DR, R DW, Sandison AT (14 May 2014). Diseases in Antiquity: A Survey of the Diseases, Injuries, and Surgery of Early Populations. Charles C. Thomas Publisher, Limited. ISBN 978-0-398-08909-2.
  8. ^ Ballantyne GH (July 1982). "Review of sigmoid volvulus: History and results of treatment". Diseases of the Colon & Rectum. 25 (5): 494–501. doi:10.1007/BF02553666. PMID 7047106. S2CID 37405850.
  9. ^ Beck D, Beck DE (2012). "23". Handbook of Colorectal Surgery: Third Edition. JP Medical Ltd. ISBN 978-1-907816-20-8. Archived from the original on 2016-08-16.