An abnormal twisting of the intestine along its longitudinal axis is defined as Volvulus. Volvulus can cause intestinal obstruction, which is a common surgical emergency. Because of its serious nature, this abdominal condition has to be diagnosed and treated as early as possible. Volvulus is characterized by sudden onset of severe abdominal pain followed by distension of abdomen. The twisting of intestine can compress the blood vessels, which compromises the blood supply to the intestine leading to gangrene or perforation of that particular segment of the intestine.
Generally volvulus occurs in that portion of the intestine which is long enough to get twisted.In adults, the usual site of volvulus is large intestine (sigmoid colon, transverse colon). In children volvulus of small intestine is frequently observed. The other common site of volvulus is Cecum and stomach.
Volvulus Of Cecum And Sigmoid Colon
It has been noted that most common site of large intestine volvulus occurs in sigmoid colon (the end portion of the large bowel). The next common site is cecum followed by transverse colon. The incidence of volvulus varies in different parts of the world; the condition is common in the region of Africa, India and other countries of south Asia, Peru and countries of South America.
Volvulus of cecum occurs when the cecum gets twisted. It happens when the right half of large intestine is lax and mobile; in normal circumstances cecum is immobile. The volvulus of cecum is always in clockwise direction. It is about twice as common in females. Volvulus of cecum can occur in a person as young as 20 to as old as 90. The symptoms are acute with abdominal pain 90%, nausea and vomiting, and constipation. In about 25% of cases there is gaseous distension which can be palpated on the right side of the abdomen.
Volvulus of sigmoid colon: it is the end section of large bowel. It is the most common form of volvulus to occur in adults. Sigmoid elongation is the normal reason; men are frequently affected than females because sigmoid colon is anatomically loner in males. The incidence is less in females due to wide pelvis in females. It is commonly associated with people suffering from neurological and psychiatric disease such as patients suffering from Parkinson’s disease, multiple sclerosis and psychiatric patients taking sedatives and psychotropic drugs. Excessive use of laxatives, cathartics and enemas are also responsible to produce volvulus of sigmoid colon.
In western countries volvulus generally occurs after 60 years while it prevalence in developing countries is slight early.
Symptoms Of Volvulus
- Severe abdominal pain is the initial and most common symptom of volvulus. The pain can spread all over the abdomen as time passes.
- Distension of abdomen is another important symptom which is elicited in voluvulus of cecum. It is usually on the right side. Abdominal distension on the left side is generally noted with sigmoid colon volvulus. In few hours, the whole abdomen becomes distended.
- Vomiting and nausea: A child suffering from volvulus may persistently vomit even with small if he is fed small portions. Vomiting is also common in adults.
- Hiccough and retching occurs before vomiting.
- There may be absolute constipation.
- If not treated early, symptoms of shock such as rapid and feeble pulse, low blood pressure, sepsis, breathing difficulty back pain fever etc may supervene.
Diagnosis And Treatment Of Volvulus
X- ray of the abdomen, barium X-ray, sonogram of the abdomen, blood tests and stool tests, a CT scan of abdomen will clinch the diagnosis.
Once the diagnosis is confirmed, the surgeon considers the severity and location of the volvulus as well as the health condition of the patient. In adults non surgical approach for sigmoid colon is sigmoidoscopy to check for infarction and an attempt is made to deflate the bowel. Passing of flatus and reduction of pain will indicate good response to conservative approach.
If the symptom does not improve, laparotomy is necessary. The twisted part of the bowel is untwisted and the blood circulation is restored. If certain part of the intestine becomes dead, it is removed and colostomy is performed.