Volvulus overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Hadeel Maksoud M.D.[2]
Overview
A volvulus is a loop of the bowel whose nose has twisted on itself.[1][2] The American Heritage Stedman's Medical Dictionary defines volvulus slightly differently as "abnormal twisting of the intestine causing obstruction," which adds obstruction in the definition, and would be more clinically significant term.
Historical Perspective
Classification
Pathophysiology
Regardless of cause, volvulus causes symptoms by two mechanisms. One is bowel obstruction, manifested as abdominal distension and vomiting. The other is ischemia (loss of blood flow) to the affected portion of intestine. This causes severe pain and progressive injury to the intestinal wall, with accumulation of gas and fluid in the portion of the bowel obstructed.[3] Ultimately, this can result in necrosis of the affected intestinal wall, acidosis, and death. Acute volvulus therefore requires immediate surgical intervention to untwist the affected segment of bowel and possibly resect any unsalvageable portion.[4]
Causes
Midgut volvulus occurs in patients (usually in infants) that are predisposed because of congenital intestinal malrotation. Segmental volvulus occurs in patients 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.
Differentiating Volvulus from other Diseases
Epidemiology and Demographics
Risk Factors
Young children and children with a birth defect called intestinal malrotation are at higher risk for developing volvulus.
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Blood tests to check electrolytes.
Imaging Findings
Other Diagnostic Studies
Stool guaiac test (shows blood in the stool)
Treatment
Medical Therapy
Surgery
Emergency surgery is needed to repair the volvulus. A surgical cut is made in the abdomen. The bowels are untwisted and the blood supply restored.
If a small segment of bowel is dead from a lack of blood flow (necrotic), it is removed. The ends of the bowel are sewn back together. Or, they are used to form a connection of the intestines to the outside, through which bowel contents can be removed (colostomy or ileostomy).
Prevention
References
- ↑ Medical Terminology Systems: A Body Systems Approach, 2005
- ↑ The American Heritage Stedman's Medical Dictionary. "KMLE Medical Dictionary Definition of volvulus".
- ↑ Medical Terminology Systems: A Body Systems Approach, 2005
- ↑ Medical Terminology Systems: A Body Systems Approach, 2005