Volvulus

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Overview
A volvulus is a loop of the bowel whose nose has twisted on itself. The American Heritage Stedman's Medical Dictionary defines volvulus slightly differently as "abnormal twisting of the intestine causing obstruction," which adds obstruction in the definition, and would be more clinically significant term.

Types

 * Gastric volvulus (click on the link in blue to read more about this specific type of volvulus)
 * Volvulus Neonatorum
 * Volvulus Small Intestine
 * Volvulus Caecum
 * Volvulus Sigmoid Colon

Causes
Midgut volvulus occurs in patients (usually in infants) that are predisposed because of congenital intestinal malrotation. 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, transverse colon, or sigmoid colon occurs, usually in adults, with only minor predisposing factors such as redundant (excess, inadequately supported) intestinal tissue and constipation.

Presentation
Regardless of cause, volvulus causes symptoms by two mechanisms. One is bowel obstruction, manifested as abdominal distension and vomiting. The other is ischemia (loss of blood flow) to the affected portion of intestine. This 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 of the affected intestinal wall, acidosis, and death. Acute volvulus therefore requires immediate surgical intervention to untwist the affected segment of bowel and possibly resect 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 patient. Patients experience abdominal pain, distension, and absolute constipation.

Associated conditions
The volvulus can also occur in patients with Duchenne muscular dystrophy due to the smooth muscle dysfunction.

Investigations

 * Abdominal x-ray
 * Upper GI series

Treatment

 * Laparotomy
 * Untwisting
 * Transduodenal band of ladd is divided

Additional Resources


Volvulus Volvulus