Twisting of part of the intestine, causing a bowel obstruction / From Wikipedia, the free encyclopedia

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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]

Quick facts: Volvulus, Specialty, Symptoms, Complications,...
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]

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]