Back انفتال Arabic Volvulus Azerbaijani Vòlvul Catalan Volvulus German Volvulo Esperanto Vólvulo intestinal Spanish ولولوس Persian Volvulus French Աղիների ոլորում Armenian Volvulus ID

Volvulus

Volvulus
Coronal CT of the abdomen, demonstrating a volvulus as indicated by twisting of the bowel stock
SpecialtyGeneral surgery
SymptomsAbdominal pain, abdominal bloating, vomiting, constipation, bloody stool[1][2]
ComplicationsIschemic bowel[1]
Usual onsetRapid or more gradual[2]
Risk factorsIntestinal malrotation, enlarged colon, Hirschsprung disease, pregnancy, abdominal adhesions, chronic constipation[1][3]
Diagnostic methodMedical imaging (plain X-rays, GI series, CT scan)[1]
TreatmentSigmoidoscopy, barium enema, bowel resection[3]
Frequency2.5 per 100,000 per year[4][2]

A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction.[1] Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool.[1][2] Onset of symptoms may be rapid or more gradual.[2] The mesentery may become so tightly twisted that blood flow to part of the intestine is cut off, resulting in ischemic bowel.[1] In this situation there may be fever or significant pain when the abdomen is touched.[2]

Risk factors include a birth defect known as intestinal malrotation, an enlarged colon, Hirschsprung disease, pregnancy, and abdominal adhesions.[1] Long term constipation and a high fiber diet may also increase the risk.[3] The most commonly affected part of the intestines in adults is the sigmoid colon with the cecum being second most affected.[1] In children the small intestine is more often involved.[5] The stomach can also be affected.[6] Diagnosis is typically with medical imaging such as plain X-rays, a GI series, or CT scan.[1]

Initial treatment for sigmoid volvulus may occasionally occur via sigmoidoscopy or with a barium enema.[3] Due to the high risk of recurrence, a bowel resection within the next two days is generally recommended.[3] If the bowel is severely twisted or the blood supply is cut off, immediate surgery is required.[1] In a cecal volvulus, often part of the bowel needs to be surgically removed.[3] If the cecum is still healthy, it may occasionally be returned to a normal position and sutured in place.[1][3]

Cases of volvulus were described in ancient Egypt as early as 1550 BC.[3] It occurs most frequently in Africa, the Middle East, and India.[3][7][8] Rates of volvulus in the United States are about 2–3 per 100,000 people per year.[2][4] Sigmoid and cecal volvulus typically occurs between the ages of 30 and 70.[1][9] Outcomes are related to whether or not the bowel tissue has died.[2] The term volvulus is from the Latin "volvere"; which means "to roll".[3]

  1. ^ a b c d e f g h i j k l m "Anatomic Problems of the Lower GI Tract". NIDDK. July 2013. Archived from the original on 28 July 2016. Retrieved 3 August 2016.
  2. ^ a b c d e f g h Marx J, Walls R, Hockberger R (2013). "95". Rosen's Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences. ISBN 978-1-4557-4987-4. Archived from the original on 2016-08-16.
  3. ^ a b c d e f g h i j Gingold D, Murrell Z (December 2012). "Management of colonic volvulus". Clinics in Colon and Rectal Surgery. 25 (4): 236–44. doi:10.1055/s-0032-1329535. PMC 3577612. PMID 24294126. The Papyrus Ebers, ca. 1550 BC, described the natural course of volvulus to be spontaneous reduction or "rotting" of the intestines
  4. ^ a b Gordon PH, Nivatvongs S (2007). Principles and Practice of Surgery for the Colon, Rectum, and Anus, Third Edition. CRC Press. p. 971. ISBN 978-1-4200-1799-1. Archived from the original on 2016-08-17.
  5. ^ Wilkins LW (2009). Professional Guide to Diseases. Lippincott Williams & Wilkins. p. 283. ISBN 978-0-7817-7899-2.
  6. ^ Feldman M, Friedman LS, Brandt LJ (2010). Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features (9 ed.). Elsevier Health Sciences. p. 384. ISBN 978-1-4377-2767-8. Archived from the original on 2016-08-16.
  7. ^ Brothwell DR, R DW, Sandison AT (14 May 2014). Diseases in Antiquity: A Survey of the Diseases, Injuries, and Surgery of Early Populations. Charles C. Thomas Publisher, Limited. ISBN 978-0-398-08909-2.
  8. ^ Ballantyne GH (July 1982). "Review of sigmoid volvulus: History and results of treatment". Diseases of the Colon & Rectum. 25 (5): 494–501. doi:10.1007/BF02553666. PMID 7047106. S2CID 37405850.
  9. ^ Beck D, Beck DE (2012). "23". Handbook of Colorectal Surgery: Third Edition. JP Medical Ltd. ISBN 978-1-907816-20-8. Archived from the original on 2016-08-16.

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