A volvulus is a bowel obstruction with a loop of bowel whose nose has abnormally twisted on itself.

Types

• Volvulus Neonatorum.
• Volvulus Small Intestine.
• Volvulus Caecum.
• Volvulus Sigmoid Colon (sigmoid volvulus).
• Gastric volvulus
  Gastric volvulus
  Gastric volvulus or volvulus of stomach a twisting of all or part of the stomach by more than 180 degrees with obstruction of the flow of material through the stomach, variable loss of blood supply and possible tissue death. The twisting can occur around the long axis of the stomach, this is called...
  
  .

Signs and symptoms

Regardless of cause, volvulus causes symptoms by two mechanisms.

• One is bowel obstruction
  Bowel obstruction
  Bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency...
  
  , manifested as abdominal distention and vomiting.
• The other is ischemia
  Ischemia
  In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
  
   (loss of blood flow) to the affected portion of intestine.

Volvulus causes severe pain and progressive injury to the intestinal wall, with accumulation of gas and fluid in the portion of the bowel obstructed. Ultimately, this can result in necrosis

Necrosis

Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...

 of the affected intestinal wall, acidosis

Acidosis

Acidosis is an increased acidity in the blood and other body tissue . If not further qualified, it usually refers to acidity of the blood plasma....

, and death. Acute volvulus therefore requires immediate surgical intervention to untwist the affected segment of bowel and possibly resect

Bowel resection

A bowel resection is a surgical procedure in which a part of the large or small intestine is removed. It may be performed due to cancer, necrosis, enteritis, diverticular disease, or a block in the intestine due to scar tissue...

 any unsalvageable portion.

Volvulus occurs most frequently in middle-aged and elderly men. Volvulus can also arise as a rare complication in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops.

Sigmoid volvulus is the most-common form of volvulus of the gastrointestinal tract and is responsible for 8% of all intestinal obstructions. Sigmoid volvulus is particularly common in elderly persons and constipated patients. Patients experience abdominal pain, distension, and absolute constipation.

Associated conditions

The volvulus can also occur in patients with Duchenne muscular dystrophy

Duchenne muscular dystrophy

Duchenne muscular dystrophy is a recessive X-linked form of muscular dystrophy, which results in muscle degeneration, difficulty walking, breathing, and death. The incidence is 1 in 3,000 boys. Females and males are affected, though females are rarely affected and are more often carriers...

 due to the smooth muscle dysfunction.

Causes

Midgut volvulus occurs in patients (usually in infants) that are predisposed because of congenital intestinal malrotation

Intestinal malrotation

Intestinal malrotation is a congenital anomaly of rotation of the midgut...

. Segmental volvulus occurs in patients of any age, usually with a predisposition because of abnormal intestinal contents (e.g. meconium ileus) or adhesions. Volvulus of the cecum

Cecum

The cecum or caecum is a pouch, connecting the ileum with the ascending colon of the large intestine. It is separated from the ileum by the ileocecal valve or Bauhin's valve, and is considered to be the beginning of the large intestine. It is also separated from the colon by the cecocolic...

, transverse colon

Transverse colon

The transverse colon, the longest and most movable part of the colon, passes with a downward convexity from the right hypochondrium region across the abdomen, opposite the confines of the epigastric and umbilical zones, into the left hypochondrium region, where it curves sharply on itself beneath...

, or sigmoid colon

Sigmoid colon

The sigmoid colon is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 40 cm...

 occurs, usually in adults, with only minor predisposing factors such as redundant (excess, inadequately supported) intestinal tissue and constipation.

Treatment

• Untwisting by performing sigmoidoscopy and placing rectal tube, monitor for signs of bowel ischemia for 2-3 days, if no improvement, consult surgery for laparotomy (sigmoid resection and primary anastamosis)
• Laparotomy
  Laparotomy
  A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
  
  
• Transduodenal band of ladd is divided