Types, Symptoms, Causes, Diagnosis, Treatment

Volvulusalso known as twisted or rotating intestine, causes intestinal obstructions when the intestine twists on itself. It can block blood flow to the intestine, causing serious damage if not treated promptly.

Volvulus can occur anywhere in the gastrointestinal tract (the long tube in your body that connects your mouth to your anus). The exact type of volvulus you have will depend on where the torsion occurs.

Any type of volvulus can lead to serious complications if not treated promptly. It is therefore crucial to recognize the signs and consult a doctor as soon as possible.

Sigmoid volvulus

Sigmoid volvulus occurs when the sigmoid colon, the part of your large intestine close to the rectum, twists on itself. This is the most common type among adults.

When the sigmoid colon and mesentery twisting, this can cut off blood flow, leading to severe pain, bloating and constipation. Without prompt treatment, this can cause tissue damage, perforation or infection, which can be life-threatening.

Cecal volvulus

Cecal volvulus occurs when caecum and the ascending colon, which are part of the large intestine, undergo rotation or twisting.

This type of volvulus accounts for a smaller percentage of large intestinal obstructions, but can lead to serious complications if left untreated.

Midgut volvulus

Midgut volvulus is more common in infants and children. This occurs when the small intestine and parts of the large intestine become twisted, often related to congenital malrotation, an abnormal development before birth.

In these cases, the intestines are more prone to twisting or blockages because they are not in the usual position.

Gastric volvulus

Gastric volvulus is a rare condition in which the stomach twists on itself. This can occur when the stomach rotates at least 180 degrees.

When this happens, your stomach can lose its blood supply, increasing the risk of serious complications. Urgent medical treatment is needed for this condition.

Symptoms of volvulus vary depending on the location and severity. Common signs include:

• Severe cramps
• Abdominal pain or tenderness
• Bloating
• Nausea and vomiting
• Constipation
• Diarrhea
• Stool changes
• Bloody stools
• Fever
• Signs of shock, such as rapid heartbeat, low blood pressure, and dizziness

Certain conditions and situations increase your risk of volvulus. Sometimes the cause is unclear, but it often results from a mixture of intestinal factors.

Common risk factors include:

• Intestinal malrotation: A congenital disability (i.e. present at birth) where the intestines are not positioned correctly
• Hirschsprung disease: A disease affecting the nerve cells in the colon, leading to problems with bowel movements
• Enlarged colon: An abnormal increase in the size of the colon
• Pregnancy: The growing uterus can push the intestines, resulting in twisting
• Abdominal adhesions: Scar tissue from previous surgeries or infections can cause the intestines to become stuck or tangled.
• Conditions like Parkinson’s disease and multiple sclerosis: Movement disorders that can affect the intestines, especially if you have been hospitalized
• Diet rich in fiber: A diet with excessive fiber intake, combined with chronic constipation, can increase the risk of volvulus.
• Chronic use of laxatives or enemas: Regular use of these medications may affect bowel movements and increase the risk of bowel rotation.
• Myopathy: Muscle disorders such as Duchenne muscular dystrophy may be associated with a higher risk of volvulus

If you have symptoms of volvulus, seek care as soon as possible to reduce the risk of complications. During your appointment, you can expect a doctor to ask you questions about your symptoms and medical history.

They may also perform a physical exam before ordering the following tests:

These tests can detect signs of infection, inflammation, and intestinal obstruction. Your exact diagnosis will depend on your symptoms. The combination of diagnostic methods helps the doctor to accurately identify volvulus and plan appropriate treatment.

The main goal of treatment for a volvulus diagnosis is to repair the twisted part of your intestine so that it begins to function properly. A doctor will always focus on strategies to prevent this condition from recurring.

Surgical and medical procedures are the most common treatments for this condition and may include:

• Sigmoidoscopy: This procedure uses a flexible tube with a camera to examine the inside of the rectum and lower part of the colon. Although it is often a diagnostic test, a sigmoidoscopy can also help relieve torsion in some cases.
• Intestinal resection: This surgery removes the twisted and damaged segment of the intestine. Most doctors prefer this method because it reduces the risk of volvulus recurring. However, older adults with volvulus may benefit from less invasive surgery.

For cecal volvulus in particular, other treatments may include a cecopexy (which attaches the cecum to the abdominal wall) and to the right hemicolectomy (which removes the affected part of the colon).

Volvulus cannot be avoided if your bowel rotation is due to a congenital condition you were born with. However, there are steps you can take to prevent other types of volvulus from developing.

These strategies include:

• Reduce your fiber intake.
• Limit the use of laxatives or enemas.
• Get treatment for persistent constipation.

If not treated promptly, volvulus can lead to several serious complications. These include:

• Intestinal ischemia: This occurs when the blood supply to the twisted part of the intestine is interrupted, leading to tissue damage. Without good blood flow, affected parts of the intestine may begin to die, which may require surgical removal.
• Intestinal perforation: The intestine can tear if the pressure from twisting the intestine becomes too great. This perforation allows intestinal contents to leak into the abdominal cavity, potentially causing a serious infection called peritonitis.
• Sepsis: This serious infection spreads throughout the body and can occur due to intestinal perforation, necrosis or volvulus not treated in time. It is a life-threatening condition that requires immediate treatment and can lead to organ failure if not treated promptly.