Volvulus
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Overview
| Volvulus Classification and external resources | |
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| CECAL VOLVULUS 27 year old female with osteogenesis imperfecta. Patient is complaining of abdominal pain. Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology | |
| ICD-10 | K56.2 |
| ICD-9 | 537.3, 560.2 |
| DiseasesDB | 13996 |
| eMedicine | ped/2415 |
| MeSH | D045822 |
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A volvulus is a loop of the bowel whose nose has twisted on itself.[1] 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.[1]
Types
- 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.[1] 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.[1]
Volvulus occurs most frequently in middle-aged and elderly men.[1] Volvulus can also arise as a rare complication in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops.[1]
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
Treatment
- Laparotomy
- Untwisting
- Transduodenal band of ladd is divided
See also
References
Additional Resources
- Gylys, Barbara A. and Mary Ellen Wedding, Medical Terminology Systems, F.A. Davis Company, 2005.
Symptoms and signs (R00-R69, 780-789) |
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| Circulatory and respiratory systems |
Tachycardia - Bradycardia - Palpitation - Heart murmur - Nosebleed - Hemoptysis - Cough - abnormalities of breathing (Dyspnea, Orthopnoea, Stridor, Wheeze, Cheyne-Stokes respiration, Hyperventilation, Mouth breathing, Hiccup, Bradypnea, Hypoventilation) - Chest pain - Asphyxia - Pleurisy - Respiratory arrest - Sputum - Bruit |
| Digestive system and abdomen | Abdominal pain - Acute abdomen - Nausea - Vomiting - Heartburn - Dysphagia - Flatulence - Burping - Fecal incontinence - Encopresis - Hepatomegaly - Splenomegaly - Hepatosplenomegaly - Jaundice - Ascites - Fecal occult blood - Halitosis |
| Skin and subcutaneous tissue | disturbances of skin sensation (Hypoesthesia, Paresthesia, Hyperesthesia) - Rash - Cyanosis - Pallor - Flushing - Petechia - Desquamation - Induration |
| Nervous and musculoskeletal systems |
abnormal involuntary movements (Tremor, Spasm, Fasciculation, Athetosis) - Gait abnormality - lack of coordination (Ataxia, Dysmetria, Dysdiadochokinesia, Hypotonia) - Tetany - Meningism - Hyperreflexia |
| Urinary system | Dysuria - Vesical tenesmus - Urinary incontinence - Urinary retention - Oliguria - Polyuria - Nocturia |
| Cognition, perception, emotional state and behaviour |
Anxiety - Somnolence - Coma - Amnesia (Anterograde amnesia, Retrograde amnesia) - Dizziness/Vertigo - smell and taste (Anosmia, Ageusia, Parosmia, Parageusia) |
| Speech and voice | speech disturbances (Dysphasia, Aphasia, Dysarthria) - symbolic dysfunctions (Dyslexia, Alexia, Agnosia, Apraxia, Acalculia, Agraphia) - voice disturbances (Dysphonia, Aphonia) |
| General symptoms and signs | Fever (Hyperpyrexia) - Headache - Chronic pain - Malaise - Fatigue - Fainting (Vasovagal syncope) - Febrile seizure - Shock (Cardiogenic shock) - Lymphadenopathy - Edema (Peripheral edema, Anasarca) - Hyperhidrosis (Sleep hyperhidrosis) - Delayed milestone - Failure to thrive - food and fluid intake (Anorexia, Polydipsia, Polyphagia) - Cachexia - Xerostomia - Clubbing |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
