Volvulus
Marked by sudden onset of severe abdominal pain, volvulus is a twisting of the intestine at least 180 degrees on itself. Volvulus results in blood vessel compression and causes obstruction both proximal and distal to the twisted loop. (See What happens in volvulus.)
Volvulus occurs in a bowel segment long enough to twist. The most common area, particularly in adults, is the sigmoid colon. Other common sites include the stomach and cecum.
Causes
In volvulus, twisting may result from an anomaly of bowel rotation in utero, an ingested foreign body, or an adhesion. Volvulus secondary to meconium ileus may occur in patients with cystic fibrosis. In some patients, however, the cause is unknown.
Complications
Without immediate treatment, volvulus can lead to strangulation of the twisted bowel loop, ischemia, infarction, perforation, and fatal peritonitis.
Assessment
The patient with volvulus complains of severe abdominal pain and may report bilious vomiting. The history may also reveal the passage of bloody stools.
On inspection, the patient appears to be in pain. Abdominal inspection and palpation may reveal distention and a palpable mass.
Diagnostic tests
Abdominal X-rays may show multiple distended bowel loops and a large bowel without gas; in midgut volvulus, abdominal X-rays may be normal.
In cecal volvulus, barium from a barium enema fills the colon distal to the section of cecum; in sigmoid volvulus, barium may twist to a point; and, in adults, barium takes on an “ace of spades” configuration.
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