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Gastrointestinal system


Peritoneum and peritoneal cavity
Upper gastrointestinal tract disorders
Lower gastrointestinal tract disorders
Liver, gallbladder and pancreas disorders
Gastrointestinal system pathology review



0 / 8 complete
High Yield Notes
20 pages


8 flashcards
External References

Content Reviewers:

Rishi Desai, MD, MPH

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.

Hirschsprung disease, a disease of the large intestine that causes severe constipation or intestinal obstruction, therefore raises the risk for developing sigmoid volvulus.

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.





  • Classified by location

Sigmoid volvulus (most common)

Cecal volvulus

  • Causes include impaired abdominal mesentery development, pregnancy, chronic constipation

Midgut volvulus






  • Asses volvulus shape

    • Bent inner tube sign (“coffee bean” sign)

Barium enema

  • May show “bird’s beak” shape (point of twisted bowel)

  • Perforation suspected → barium contrast contraindicated

CT scan

  • Twisted mesentery (“whirlpool” sign)



  • In case of midgut volvulus/ischemia/necrosis; surgical resection if necessary


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw Hill Professional (2019)
  5. "Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process" Revista Española de Enfermedades Digestivas (2004)
  6. "Management of Colonic Volvulus" Clinics in Colon and Rectal Surgery (2012)