Intestinal Volvulus

Mid-Gut/Intestinal Volvulus:

A volvulus is a bowel obstruction in which a loop of bowel has abnormally twisted on itself.

Occurs particularly in infants that are susceptible because of congenital intestinal malrotation.

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


Signs & Symptoms

 


Regardless of cause, volvulus causes symptoms by two mechanisms.

  1. bowel obstruction, manifested as abdominal distension and vomiting.
  2. ischemia (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.[2] Ultimately, this can result innecrosis 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.[2]

Volvulus occurs most frequently in middle-aged and elderly men.[2] Volvulus can also arise as a rare complication in persons with redundant colon, a normal anatomic variation resulting in extra colonic loops.[3]

Sigmoid volvulus is the most-common form of volvulus of the gastrointestinal tract[4] 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.


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


Treatments


  1. 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)
  2. Laparotomy
  3. Transduodenal band of ladd is divided

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 organoaxial or around the axis perpendicular to this, called mesenteroaxial. Obstruction andischemia are more likely in organoaxial twisting than with mesenteroaxial. About one third of the cases are associated with ahiatus hernia. Treatment is surgical.

The classic triad of gastric volvulus, described by Borchardt in 1904, consists of severe epigastric painretching without vomitingand inability to pass a nasogastric tube.


References


 

  1. ^ volvulus at Dorland’s Medical Dictionary
  2. a b c d Wedding, Mary Ellen; Gylys, Barbara A. (2004). Medical Terminology Systems: A Body Systems Approach (Medical Terminology (W/CD & CD-ROM) (Davis)). Philadelphia, Pa: F. A. Davis Company. ISBN 0-8036-1249-4.
  3. ^ Mayo Clinic Staff (2006-10-13). “Redundant colon: A health concern?”. Ask a Digestive System Specialist. MayoClinic.com. Archived from the original on 2007-09-29. Retrieved 2007-06-11.
  4. ^ Turan M, Sen M, Karadayi K, et al. (January 2004). “Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process”. Rev Esp Enferm Dig 96 (1): 32–5.PMID 14971995.

Schaefer D, Nikoomenesh P, Moore C (1997). “Gastric volvulus: an old disease process with some new twists”. Gastroenterologist 5 (1): 41–5. PMID 9074918

Wikipedia Site Reference (Midgut Volvulus)