CAUSES & CONDITIONS

Midgut Volvulus

Intestinal & gastric volvulus — signs, types, and emergency management

A volvulus is a critical medical emergency in which a segment of the gastrointestinal tract abnormally twists upon itself. This twisting compromises both the flow of digestive contents and the vital blood supply to the organs.

INTESTINAL
Midgut & Intestinal Volvulus

Intestinal volvulus primarily impacts two groups: infants (due to congenital anomalies) and older adults (due to acquired structural changes).

🚨

Signs & symptoms

A volvulus triggers symptoms through two mechanisms:

Bowel obstruction — severely swollen belly (abdominal distension) and vomiting
Ischemia (loss of blood flow) — severe pain, tissue death (necrosis), metabolic acidosis, and shock
Types & age distribution

Infants (midgut volvulus) — highly vulnerable due to congenital intestinal malrotation (intestines do not properly fixate in the abdomen during fetal development)
Middle-aged & elderly men — most prone to colonic volvulus, sometimes as a complication of a redundant (extra, floppy) colon
Segmental volvulus (all ages) — often predisposed by adhesions (scar tissue) or abnormal intestinal contents (e.g., meconium ileus in newborns)
Sigmoid volvulus — the most prevalent form in the GI tract, accounting for about 8% of all intestinal obstructions, especially in elderly people with chronic constipation

STOMACH
Gastric Volvulus

Gastric volvulus occurs when the stomach twists or rotates abnormally. This can block the stomach entirely and cut off its blood supply, risking tissue death and perforation.

Borchardt’s triad (classic presentation)

First described in 1904:

1. Severe, sudden upper abdominal (epigastric) pain
2. Violent dry heaving / retching without the ability to vomit
3. Inability to pass a nasogastric (NG) tube into the stomach
Organic gastric volvulus

Structural defect or weakness in the ligaments that hold the stomach in place; often linked to other abnormalities such as hiatal hernia.

Primary gastric volvulus

Less common. Sudden, complete rotation of the stomach — sometimes triggered by severe trauma or intense physical activity.

TREATMENT
Clinical Management

All forms of volvulus are time-sensitive emergencies.

Suspected volvulus → Immediate imaging → Decompression or surgery

Delayed treatment increases the risk of gangrene, perforation, and sepsis.

Non-surgical decompression (sigmoid volvulus)

For stable adult patients, clinicians may use flexible sigmoidoscopy to untwist the bowel and place a temporary rectal tube to release trapped gas and fluid. Patients are monitored in hospital for 2–3 days for delayed signs of ischemia.

Surgical intervention (laparotomy)

Required if the patient is unstable, the stomach is twisted, or non-surgical untwisting fails:

• Untwisting — surgeon manually unwinds the stomach or intestine
• Intestinal resection — removal of dead, necrotic bowel tissue
• Primary anastomosis — for sigmoid volvulus, the loose segment is removed and healthy ends reconnected to prevent recurrence

RELATED
Continue Learning

Note
This information is for educational purposes only and is not a substitute for professional medical advice. Always consult your medical team for diagnosis and treatment decisions.