Medical Review: Volvulus

Volvulus is a blockage of the intestine as a result of abnormal twisting. Sigmoid volvulus occurs when the sigmoid colon becomes twisted and it is the most common form of volvulus. Cecal volvulus refers to the twisting of the cecum and ascending colon. It is a less frequent form of volvulus. Volvulus is induced by the intestine coiling around itself and the mesentery. The mesentery consists of soft tissue that is double folded peritoneum and connects the intestines to the dorsal abdominal wall. It is possible for the mesentery to get twisted tight enough to stop blood flow to the area of the intestine that is affected. This condition is a medical emergency and is life-threatening due to the damage to the area cut off from the blood supply and the possibility of tearing the wall of the intestine ("Colorectal Surgery - Volvulus (Twisting of the Colon)," n.d.).

Malrotation of the intestines can cause volvulus. Malrotation of the intestine is also known as intestinal non-rotation or incomplete rotation and pertains to any variation in the rotation and fixation of the gastrointestinal tract during development (Bensard, 2017). Other medical conditions can cause volvuli, such as abdominal adhesions, an enlarged colon, or Hirschsprung disease; a disease of the large intestine that causes obstructions or constipation.

There are multiple symptoms that indicate volvulus including abdominal cramping, signs of shock, bloody stools, vomiting and the inability to pass gas. Medical professionals use various approaches to diagnose volvulus. These tests include x rays, upper or lower GI series, CT scans, and flexible sigmoidoscopy. Sigmoidoscopy is a routine test that is performed to see inside of the rectum and lower colon and is performed using a camera attached to a flexible tube that is inserted into the anus.

Treatment of the volvulus is dependent on the severity of the condition. It is possible for a doctor to straighten the colon using the sigmoidoscope if it is not twisted too tightly. If the colon is coiled too tightly or if the colon is thought to be losing blood flow, surgery is needed immediately. “Surgery involves restoring the blood supply, if possible, to the affected part of the sigmoid colon. Sometimes the affected part of the colon must be removed and the healthy ends reattached, a procedure called an intestinal resection” (UCSF Center for Colorectal Surgery, n.d.).

When the volvulus is diagnosed and treated quickly, there is generally a successful outcome. When cecopexy and intestinal resection surgeries are needed there is a high rate of success and little chance of recurrence. When the sigmoidoscope is used to untwist the colon and relieve the condition it is more likely that the problem will reoccur.

Obstruction of the intestines is something that I understood and have read about in the past. I now understand that the occurrence of this condition is fairly uncommon in the United States. There are sparse statistics pertaining to volvulus because it is a relatively uncommon cause of an obstruction of the intestines; causing less than ten percent of the obstructions. The interesting fact is that the incidence of volvulus is much higher outside of the United States. “In contrast, sigmoid volvulus is the underlying etiology in 50 to 80 percent of patients with intestinal obstruction in other parts of the world” (Hodin, 2016). The cause of the higher rate of occurrence in other parts of the world is not known for sure. It is thought that the differing lengths of the colon in different races could be a factor. Also, it is possible that the higher occurrence of other diseases such as Crohn disease and Chagas disease in other countries could be caused by a higher incidence of volvulus.