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d as pdf printable version in other projects wikimedia commons wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia twisting of part of the intestine causing a bowel obstruction medical condition volvulus coronal ct of the abdomen demonstrating a volvulus as indicated by twisting of the bowel stock specialty general surgery symptoms abdominal pain abdominal bloating vomiting constipation bloody stool 1 2 complications ischemic bowel 1 usual onset rapid or more gradual 2 risk factors intestinal malrotation enlarged colon hirschsprung disease pregnancy abdominal adhesions chronic constipation 1 3 diagnostic method medical imaging plain x rays gi series ct scan 1 treatment sigmoidoscopy barium enema bowel resection 3 frequency 2 5 per 100 000 per year 4 2 a volvulus is a bowel obstruction resulting from a loop of intestine twisting around itself and its supporting mesentery 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 the 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 signs and symptoms edit regardless of cause volvulus causes symptoms by two mechanisms 10 bowel obstruction manifested as abdominal distension and bilious vomiting ischemia loss of blood flow to the affected portion of the intestine depending on the location of the volvulus symptoms may vary for example in patients with cecal volvulus the predominant symptoms may be those of small bowel obstruction nausea vomiting and lack of stool or flatus because the obstructing point is close to the ileocecal valve and small intestine in patients with sigmoid volvulus although abdominal pain may be present symptoms of constipation may be more prominent volvulus causes severe pain and progressive injury to the intestinal wall with accumulation of gas and fluid in the portion of the bowel obstructed 11 ultimately this can result in necrosis of the affected intestinal wall acidosis and death this is known as a closed loop obstruction because there exists an isolated closed loop of bowel acute volvulus often requires immediate surgical intervention to untwist the affected segment of bowel and possibly resect any unsalvageable portion 11 volvulus occurs most frequently in middle aged and elderly men 11 volvulus can also arise as a rare complication in persons with redundant colon a normal anatomic variation resulting in extra colonic loops 12 sigmoid volvulus is the most common form of volvulus of the gastrointestinal tract 13 and is responsible for 8 of all intestinal obstructions citation needed sigmoid volvulus is particularly common in elderly persons and constipated patients patients experience abdominal pain distension and absolute constipation cecal volvulus is slightly less common than sigmoid volvulus and is associated with symptoms of abdominal pain and small bowel obstruction it has been associated to several diseases including huntington s disease 14 volvulus can also occur in patients with duchenne muscular dystrophy due to smooth muscle dysfunction citation needed gastric volvulus causes nausea vomiting and pain in the upper abdomen the borchardt triad is a group of symptoms that help doctors identify gastric volvulus the symptoms are intractable retching pain in the upper abdomen and inability to pass a nasogastric tube into the stomach 15 complications edit strangulation gangrene perforation faecal peritonitis recurrent volvulus causes edit midgut volvulus occurs in people usually babies who are predisposed because of congenital intestinal malrotation segmental volvulus occurs in people of any age usually with a predisposition because of abnormal intestinal contents e g meconium ileus or adhesions volvulus of the cecum transverse colon or sigmoid colon occurs usually in adults with only minor predisposing factors such as redundant excess inadequately supported intestinal tissue and constipation 16 types edit volvulus neonatorum volvulus of the small intestine midgut volvulus due to intestinal malrotation volvulus of the caecum cecum also cecal volvulus sigmoid colon volvulus sigmoid volvulus volvulus of the transverse colon volvulus of the splenic flexure the rarest gastric volvulus ileosigmoid knot diagnosis edit after taking a thorough history the diagnosis of colonic volvulus is usually easily included in the differential diagnosis abdominal plain x rays are commonly confirmatory for a volvulus especially if a coffee bean sign is seen these refer to the shape of the air filled closed loop of the colon which forms the volvulus should the diagnosis be in doubt a barium enema may demonstrate a bird s beak at the point where the segment of proximal bowel and distal bowel rotate to form the volvulus citation needed this area shows an acute and sharp tapering and looks like a bird s beak if a perforation is suspected barium should not be used due to its potentially lethal effects when distributed throughout the free intraperitoneal cavity gastrografin which is safer can be substituted for barium citation needed the differential diagnosis includes the much more common constricting or obstructing carcinoma in approximately 80 percent of colonic obstructions invasive carcinoma is found to be the cause this is usually easily diagnosed with endoscopic biopsies diverticulitis is a common condition with different presentations although diverticulitis may be the source of a colonic obstruction it more commonly causes an ileus which appears to be a colonic obstruction 17 endoscopic means can be used to secure a diagnosis although this may cause a perforation of the inflamed diverticular area ct scanning is the more common method to diagnose diverticulitis the scan will show mesenteric stranding in the involved segment of edematous colon which is usually in the sigmoid region microperforations with free air may be seen citation needed ulcerative colitis or crohn s disease may cause colonic obstruction the obstruction may be acute or chronic and after years of uncontrolled disease it leads to the formation of strictures and fistulas the medical history is helpful in that most cases of inflammatory bowel disease are well known to both the patient and doctor other rare syndromes including ogilvie s syndrome chronic constipation and impaction may cause a pseudo obstruction 18 abdominal x ray tire like shadow arising from the right iliac fossa and passing to the left upper gi series coffee bean sign in a person with sigmoid volvulus coronal view of sigmoid volvulus with whirlpool sign ct scan of a small bowel volvulus it shows two juxtaposed segments of narrowing which is the spot of mesentery rotation the other signs indicate strangulation an x ray of a person with a small bowel volvulus plain x ray of a cecal volvulus ct scan of a cecal volvulus treatment edit volvulus with gangrene of the sigmoid sigmoid edit treatment for sigmoid volvulus may include sigmoidoscopy if the mucosa of the sigmoid looks normal and pink a rectal tube for decompression may be placed and any fluid electrolyte cardiac kidney or pulmonary abnormalities should be corrected the affected person should then be taken to the operating room for surgical repair if surgery is not performed there is a high rate of recurrence 10 for people with signs of sepsis or an abdominal catastrophe immediate surgery and resection are advised cecal edit in a cecal volvulus the cecum may be returned to a normal position and sutured in place a procedure known as cecopexy 1 if identified early before presumed intestinal wall ischemia has resulted in tissue breakdown and necrosis the cecal volvulus can be detorsed laparoscopically 19 other edit laparotomy for other forms of volvulus especially anal volvulus references edit 1 2 3 4 5 6 7 8 9 10 11 12 13 14 anatomic problems of the lower gi tract niddk july 2013 archived from the original on 28 july 2016 retrieved 3 august 2016 1 2 3 4 5 6 7 8 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 1 2 3 4 5 6 7 8 9 10 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 1 2 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 wilkins lw 2009 professional guide to diseases lippincott williams wilkins p 283 isbn 978 0 7817 7899 2 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 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 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 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 1 2 volvulus the lecturio medical concept library retrieved 12 july 2021 1 2 3 wedding mary ellen gylys barbara a 2004 medical terminology systems a body systems approach medical terminology w cd cd rom davis philadelphia pa f a davis company isbn 0 8036 1249 4 mayo clinic staff 2006 10 13 redundant colon a health concern ask a digestive system specialist mayoclinic com archived from the original on 2007 09 29 retrieved 2007 06 11 turan m sen m karadayi k et al january 2004 our sigmoid colon volvulus experience and benefits of colonoscope in detortion process rev esp enferm dig 96 1 32 5 doi 10 4321 s1130 01082004000100005 pmid 14971995 archived from the original on 2011 07 11 ferrer inaebnit e segura sampedro jj molina romero fx gonzález argenté x october 2020 oclusión e isquemia por vólvulo de ciego en corea de huntington gastroenterología y hepatología in spanish 43 10 633 634 doi 10 1016 j gastrohep 2020 03 005 pmid 33051047 s2cid 241550167 peterson cm anderson js hara ak carenza jw menias co september 2009 volvulus of the gastrointestinal tract appearances at multimodality imaging radiographics 29 5 1281 1293 doi 10 1148 rg 295095011 issn 0271 5333 pmid 19755596 le ck nahirniak p anand s cooper w 2023 volvulus national center for biotechnology information u s national library of medicine pmid 28722866 retrieved 12 july 2021 hoffman gary h 2007 08 16 diverticulosis diverticulitis for physicians time to call the surgeon los angeles colon and rectal surgical associates lacolon com archived from the original on 2013 02 26 retrieved 2012 07 07 hoffman gary h 2009 10 27 what is constipation what can be done about constipation los angeles colon and rectal surgical associates lacolon com archived from the original on 2012 06 13 retrieved 2012 07 06 jones rg wayne ej kehdy fj may 2012 laparoscopic detorsion and cecopexy for treatment of cecal volvulus the american surgeon 78 5 e251 252 doi 10 1177 000313481207800503 issn 1555 9823 pmid 22546094 s2cid 5812146 external links edit wikimedia commons has media related to volvulus classification d icd 10 k56 2 icd 9 cm 537 3 560 2 mesh d045822 diseasesdb 13996 external resources emedicine ped 2415 ct of an abdomen with sigmoid volvulus v t e diseases of the human digestive system upper gi tract esophagus esophagitis candidal eosinophilic herpetiform rupture esophageal rupture mallory weiss syndrome zenker s diverticulum barrett s esophagus esophageal motility disorder nutcracker esophagus esophageal achalasia esophagogastric junction outflow obstruction diffuse esophageal spasm gastroesophageal reflux disease gerd laryngopharyngeal reflux lpr esophageal stricture inlet patch megaesophagus esophageal intramural pseudodiverticulosis acute esophageal necrosis stomach gastritis atrophic ménétrier s disease gastroenteritis peptic gastric ulcer cushing ulcer dieulafoy s lesion indigestion functional dyspepsia pyloric stenosis achlorhydria gastroparesis gastroptosis portal hypertensive gastropathy gastric antral vascular ectasia dumping syndrome gastric volvulus buried bumper syndrome gastrinoma zollinger ellison syndrome lower gi tract enteropathy small intestine duodenum jejunum ileum enteritis duodenitis jejunitis ileitis peptic duodenal ulcer curling s ulcer malabsorption coeliac tropical sprue blind loop syndrome small intestinal bacterial overgrowth whipple s short bowel syndrome steatorrhea milroy s disease bile acid malabsorption large intestine appendix colon appendicitis colitis pseudomembranous ulcerative ischemic microscopic collagenous lymphocytic dysentery functional gastrointestinal disorder ibs intestinal pseudo obstruction ogilvie syndrome megacolon toxic megacolon diverticulitis diverticulosis scad large and or small enterocolitis necrotizing gastroenterocolitis ibd crohn s disease vascular abdominal an...