| Volvulus | |
|---|---|
 | |
| Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock | |
| Specialty | General surgery |
| Symptoms | Abdominal pain, abdominal bloating, vomiting, constipation, bloody stool[1][2] |
| Complications | Ischemic bowel[1] |
| Usual onset | Rapid or more gradual[2] |
| Risk factors | Intestinal malrotation, enlarged colon, Hirschsprung disease, pregnancy, abdominal adhesions, chronic constipation[1][3] |
| Diagnostic method | Medical imaging (plain X-rays, GI series, CT scan)[1] |
| Treatment | Sigmoidoscopy, barium enema, bowel resection[3] |
| Frequency | 2.5 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] 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][7] 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]
References edit
- ^ 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.
- ^ a b c d e f g h Marx, John; Walls, Ron; Hockberger, Robert (2013). "95". Rosen's Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences. ISBN 1455749877. Archived from the original on 2016-08-16.
- ^ 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.
- ^ a b Gordon, Philip H.; Nivatvongs, Santhat (2007). Principles and Practice of Surgery for the Colon, Rectum, and Anus, Third Edition. CRC Press. p. 971. ISBN 9781420017991. Archived from the original on 2016-08-17.
- ^ Wilkins, Lippincott Williams & (2009). Professional Guide to Diseases. Lippincott Williams & Wilkins. p. 283. ISBN 9780781778992.
- ^ Feldman, Mark; Friedman, Lawrence S.; Brandt, Lawrence J. (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 1437727670. Archived from the original on 2016-08-16.
- ^ Beck, David; Beck, David E. (2012). "23". Handbook of Colorectal Surgery: Third Edition. JP Medical Ltd. ISBN 9781907816208. Archived from the original on 2016-08-16.