Intestinal Volvulus

Mid-Gut/Intestinal Volvulus:

Mid-Gut/Intestinal Volvulus is a condition characterized by a bowel obstruction wherein a segment of the intestine has abnormally twisted upon itself. This medical phenomenon is more commonly observed in infants, who are inherently vulnerable due to congenital intestinal malrotation. It is important to note that there are variations in the manifestation of volvulus, with segmental volvulus being prevalent across various age groups. In such cases, individuals may exhibit a predisposition to this condition, often attributed to factors such as abnormal intestinal contents (e.g., meconium ileus) or the presence of adhesions. This underscores the diverse nature of mid-gut or intestinal volvulus, emphasizing the need for comprehensive understanding and medical attention across different demographic groups.

 

 

Signs & Symptoms

Volvulus leads to symptoms through two mechanisms, regardless of its cause:

  1. Bowel obstruction is evident through abdominal distension and vomiting.
  2. Ischemia (loss of blood flow) occurs in the affected part of the intestine.

This condition induces severe pain and progressive damage to the intestinal wall, causing the accumulation of gas and fluid in the obstructed bowel segment. Ultimately, it can lead to necrosis of the affected intestinal wall, acidosis, and even death. Immediate surgical intervention is crucial for acute volvulus to untwist the affected bowel segment and potentially remove any irreparable portions.

Volvulus is more common in middle-aged and elderly men. It can also occur as a rare complication in individuals with a redundant colon, a normal anatomical variation resulting in extra colonic loops.

Among the various forms of volvulus in the gastrointestinal tract, sigmoid volvulus is the most prevalent, accounting for 8% of all intestinal obstructions. This type is particularly common in elderly individuals and those experiencing constipation, leading to symptoms such as abdominal pain, distension, and absolute constipation.

Causes

Midgut volvulus is more likely to occur in individuals, typically infants, who have a predisposition due to congenital intestinal malrotation. Segmental volvulus can affect individuals of any age, often with a predisposition caused by abnormal intestinal contents (such as meconium ileus) or adhesions. On the other hand, volvulus of the cecum, transverse colon, or sigmoid colon typically manifests in adults, where minor predisposing factors like redundant (excess, inadequately supported) intestinal tissue and constipation may contribute to its occurrence.

Treatments

  1. Untwisting by performing sigmoidoscopy and placing rectal tube, monitor for signs of bowel ischemia for 2-3 days, consult surgery for laparotomy (sigmoid resection and primary anastamosis)
  2. Laparotomy
  3. Intestinal Resection of Dead Bowel

Gastric Volvulus

Gastric volvulus is a medical condition characterized by the abnormal twisting or rotation of the stomach. This rotation can lead to obstruction of the stomach and interfere with its blood supply. Gastric volvulus can be classified into two main types:

  1. Organic Gastric Volvulus: This occurs when there is a defect or weakness in the supporting ligaments of the stomach, allowing it to twist abnormally. It is often associated with other anatomical abnormalities.
  2. Primary Gastric Volvulus: This type is less common and usually involves a sudden and complete rotation of the stomach, often due to an event such as trauma or vigorous physical activity.

Symptoms of gastric volvulus may include severe abdominal pain, bloating, difficulty swallowing, nausea, and vomiting. It is considered a medical emergency, as it can lead to complications such as tissue necrosis and perforation.

Treatment typically involves addressing the rotation of the stomach through surgical intervention. The specific approach depends on the type and severity of the volvulus. Early diagnosis and prompt medical attention are crucial for a better outcome. If you suspect gastric volvulus, it is important to seek immediate medical assistance.

The classic triad of gastric volvulus, described by Borchardt in 1904, consists of severe epigastric pain, retching without vomiting and inability to pass a nasogastric tube.

References

^ volvulus at Dorland’s Medical Dictionary

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.

^ 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.

^ 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)