Volvulus

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.