Summary of Volvulus
PATHOLOGY & CAUSES
- Intestinal twisting/looping
- Classified by location
Sigmoid volvulus (most common)
Usually middle-aged/elderly individuals
Causes include pregnancy, chronic constipation (e.g. Hirschsprung’s disease), intestinal adhesions
- Causes include impaired abdominal mesentery development, pregnancy, chronic constipation
Usually infants/young children
Caused by anomalous intestinal development (e.g. intestinal malrotation)
Mesenteric artery compression → intestinal wall ischemia, infarction
Intestinal wall perforation, infection (e.g. diffuse peritonitis)
SIGNS & SYMPTOMS
- Abdominal tenderness, pain, distension, bilious vomiting, constipation, fever, auscultation (abnormal bowel sounds, often decreased), percussion (tympany), hematochezia (may indicate bowel ischemia, necrosis)
Asses volvulus shape
- Bent inner tube sign (“coffee bean” sign)
May show “bird’s beak” shape (point of twisted bowel)
Perforation suspected → barium contrast contraindicated
- Twisted mesentery (“whirlpool” sign)
- In case of midgut volvulus/ischemia/necrosis; surgical resection if necessary
IV fluid replacement
Sigmoid volvulus: sigmoidoscopy
Cecal volvulus: colonoscopy
Transcript for Volvulus
Content Reviewers:Rishi Desai, MD, MPH, Kyle Slinn, RN, BScN, MEd, Vincent Waldman, PhD, Tanner Marshall, MS
The term volvulus actually comes from the Latin word volvere, which means “to roll”.
So a volvulus is an obstruction caused by a loop of the intestine that rolls or twists around itself and its surrounding mesentery, which is the tissue that attaches the intestine to the back wall of the abdomen.
The three most common types of volvulus are a sigmoid volvulus, which happens in the the last part of the large intestine, leading to the rectum; a cecal volvulus, which happens in the beginning of the large intestine, and a midgut volvulus, which happens in the small intestine.
Now, a sigmoid volvulus is the most common type of volvulus, and it can happen in a variety of settings.
One classic one being pregnancy, because the growing fetus can cause displacement and twisting of the colon.
It can also develop, though, in middle-aged and elderly individuals.
This can sometimes happen as a result of chronic constipation, where a big load of stool can act like a pivot point around which the rest of the colon can twist.
In addition, there are also abdominal adhesions, where internal scar tissue creates a physical attachment between two parts of the abdomen, which again serves as a pivot point around which the colon can twist.
A cecal volvulus is usually found in young adults, and usually happens in individuals who didn’t develop their abdominal mesentery normally during fetal development.
Since some mesentery contacts may be missing in these individuals, the colon can flop around freely and any large object—like a baby in pregnancy or a load of stool in someone constipated—can act as a pivot point in the cecum and cause the colon to twist.
Midgut volvulus is most commonly found in babies and small children and is the result of abnormal intestinal development in fetuses.
In normal fetal development, the digestive tract starts as a straight tube from the stomach to the rectum.
For a little while, a part of the intestine protrudes from the abdomen into the umbilical cord.
Once the fetus reaches around 10 weeks, though, the intestine pulls back out of the umbilical cord, and returns to the abdominal cavity and makes two turns, so that it is no longer a straight tube.
Malrotation happens when the cecum and appendix, which are normally found in the lower right side of the abdomen, stay in the upper right side.
Babies with malrotation can later develop twisting of the small intestine, which is a midgut volvulus.
In any type of volvulus, a portion of the intestines becomes twisted and it pinches the lumen shut and results in bowel obstruction, which prevents the normal passage of digested food and water.