Volvulus Explained: Symptoms, Causes, and Treatment
Volvulus can cause severe pain and cut off the blood supply to the part of the bowel downstream of it. Doctors may use specific types of endoscopy to unravel it or perform surgery to remove the twisted part of the intestine.
The stomach can also develop volvulus.
This article will focus on the causes, types, diagnosis, and treatment of volvulus.
Volvulus is when a loop of the intestine has twisted around itself at a point along the gastrointestinal (GI) tract. It can affect any part of the bowel, but it usually affects the large bowel, or colon.
Your intestines are muscular tubes that digest and propel food and its waste products (stool) down to the rectum and out of the body. Various conditions can affect the muscles and other aspects of the bowel. It can lead to loose or extra bowel that is more likely to loop and twist. You can be born with an intestinal condition or acquire it as you age.
Volvulus may result in bowel obstruction. This means that intestinal contents cannot pass through and may cause a hole in the intestinal wall. Volvulus can also reduce or stop blood flow to the tissue. This causes serious damage. A bowel obstruction is a medical emergency.
Rarely, volvulus involves the stomach. This is a very serious condition known as gastric volvulus.
Volvulus and its symptoms can happen slowly or suddenly. The volvulus traps intestinal contents (gas and stool), becoming enlarged.
Contact a doctor straight away for the following symptoms of volvulus or its complications. Symptoms may include:
Sometimes, volvulus is a medical emergency. Call 911 for:
- swollen belly
- persistent vomiting
- severe abdominal pain
- symptoms of shock:
- change in the level of consciousness
- fast heart rate
- pale skin
The main types of intestinal volvulus are midgut and colonic. Gastric volvulus is a rare type of volvulus.
The midgut starts in the small intestine and extends to around the middle of the colon. Midgut volvulus is a spiral-like twisting of the bowel. Another name for midgut volvulus is small bowel volvulus.
Intestinal malrotation is the main cause. This is a birth anomaly where the intestines are in a different position.
Midgut volvulus most often occurs within the first year of life, but it can occur in older individuals. It is a life threatening condition that requires emergency surgery.
Sigmoid and cecal volvulus are the two most common types of colonic volvulus, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The sigmoid colon is approximately the last third of the colon, before the rectum. Sigmoid volvulus is more common in older males who:
- have a chronic medical or nervous system condition
- reside in a nursing home or psychiatric facility
The cecum is the last part of the small bowel and the beginning part of the large bowel on the right side of the body. Cecal volvulus is more common in females between 20–30 years old.
Causes of colonic volvulus can involve structural differences that allow the intestines to move more than usual. Factors that make colonic volvulus more likely include:
- high fiber diet
- chronic constipation
- frequent use of laxatives
- abdominal adhesions, which are bands of scar tissue from prior surgery
- Hirschsprung disease, a birth anomaly that blocks the movement of stool through the colon
- Chagas disease, a parasitic infection that can enlarge the colon
Gastric volvulus happens when the stomach twists more than 180° around itself, leading to obstruction. It can occur in children and adults.
Some causes of gastric volvulus include:
- hiatal hernia
- paralysis of the phrenic nerve, which controls your diaphragm
- abdominal adhesions
- structural anomalies
People who have gastric volvulus may present with three signs and symptoms known as Borchardt’s triad:
- sudden and severe abdominal pain
- uncontrollable vomiting noises without actually vomiting
- inability to guide a nasogastric tube (from the nose to the gut)
Your doctor will perform a physical exam, feel your abdomen, and ask about your medical history and potential risk factors. They will also use a stethoscope to listen to your abdomen for sounds of movement.
Tests may include:
Treatment depends on the specific type of volvulus but usually involves surgery. The goal of treatment is to unravel the volvulus, minimize complications, and prevent it from happening again. Sometimes the surgeon has to remove part of the intestine.
Midgut volvulus requires surgery. The surgeon unravels the intestine to relieve the obstruction. Watchful observation continues in case it twists again. The surgeon will need to remove any damaged tissue.
If there is no damage to the colon, the doctor may attempt to unravel the volvulus using flexible sigmoidoscopy. This procedure involves inserting a lighted tube up the rectum to the volvulus.
The surgeon may need to remove the area after untwisting it. Partial colectomy or bowel resection are clinical terms for the procedure. The doctor reconnects the new ends of the bowel or creates a colostomy.
Bowel resection is absolutely necessary if there is colon damage.
Cecal volvulus requires surgery. Studies indicate the time to treatment should be within 24-72 hours of diagnosis. The surgeon performs a partial colectomy and reattaches the new ends. Sometimes, instead of colectomy, they can untwist the cecum and secure it to the abdominal wall to prevent future volvulus.
Surgery is necessary to treat gastric volvulus. The goal is to save the stomach and prevent recurrence while stabilizing the underlying cause.
Many factors affect the long-term outlook after volvulus treatment. Possible complications include:
Prompt diagnosis and treatment of volvulus can be lifesaving and prevent complications.
The recurrence rate of colonic volvulus may be as high as 40–60% for nonsurgical treatment (sigmoidoscopy), so surgery may be a better long-term treatment. Mortality rates appear to be higher for cecal volvulus than sigmoid volvulus.
Saurabh Sethi, M.D., reviewed the following frequently asked questions.
What is the most common type of volvulus?
The most common type of volvulus in adults is sigmoid volvulus. The most common type in children is midgut volvulus, or small bowel volvulus.
Who is at risk of developing volvulus?
Volvulus is most common in adults between the ages of 50 and 80. The following factors increase the chance of volvulus:
- chronic constipation
- chronic medical condition
- chronic nervous system condition
- residence in long-term care facility
Can volvulus resolve by itself?
Isolated case studies indicate a cecal volvulus has the potential to resolve without treatment, but it does not often do so. Surgery is generally the first-line treatment for volvulus, according to the NIDDK.
Volvulus is when part of the intestine or stomach twists around itself and causes an obstruction. Volvulus is a very painful as well as life threatening GI condition. Causes and risk factors for volvulus depend on the type. Prompt diagnosis and treatment increases the chance of a positive outcome and minimizes the chance of serious complications.