Volvulus-Adult
Definition
A volvulus occurs when part of the large intestine is twisted or rotated on itself and the mesentery. Mesentery is supportive tissue that anchors the intestines to the back wall of the abdomen. The twisted intestine creates a bowel obstruction that cuts off the intestine’s blood supply and affects bowel function.

Volvulus can occur anywhere in the large intestine, but it is most common in the sigmoid colon, the lowest part near the rectum.

A volvulus requires immediate medical attention.

Causes
It is not known what causes the twisting to happen. It may result in a bowel obstruction.

Risk Factors
Volvulus is more common in older, inactive people, especially those in assisted living facilities. Other factors that may increase your chance of volvulus include:

  • Congenital defects
    • Elongated or enlarged colon
    • Sigmoid colon unattached to abdominal wall
    • Narrow mesenteric connection to the colon
  • Previous volvulus
  • History of chronic constipation
  • History of mental health disorders
  • History of adhesions
  • Hirschsprung disease
Symptoms
Symptoms may include:

Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Imaging tests will be needed to see internal structures. Tests include:

Treatment
The treatment goal is to unblock the obstruction and restore bowel function. Parts of the treatment may include:

Hydration
IV fluids may be given to prevent dehydration and shock. You may need a nasogastric tube to help prevent the build-up of gas in the stomach. A nasogastric tube is a tube inserted through the nose, down the esophagus, and into the stomach.

Sigmoidoscopy
A sigmoidoscope is a tube inserted into the colon through the rectum. The tube allows for the passage of a lighted camera and small surgical instruments. Your doctor can untwist the intestine during this procedure. Untwisting the intestine helps restore blood flow and bowel function. Depending on the extent of intestinal damage, further surgery may be necessary.

Surgery
If necessary, the section of intestine that is damaged is removed. The two remaining healthy ends are put together with stitches or staples.

Prevention
There are no current guidelines to prevent volvulus. There are several surgical procedures that may help reduce your chance of having another volvulus. Talk with your doctor about what options may be best for you.




RESOURCES:
American Gastroenterological Society

American College of Surgeons

CANADIAN RESOURCES:
Canadian Association of Gastroenterology

Canadian Association of General Surgeons

References:
Antatomic problems of the lower GI tract. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/anatomiccolon/index.aspx. Updated December 28, 2012. Accessed June 14, 2013.

Lal SK, Morgenstern R, et al. Sigmoid volvulus an update. Gastrointest Endosc Clin N Am. 2006;16(1):175-187.

Osiro SB, Cunningham D, et al. The twisted colon: a review of sigmoid volvulus. Am Surg. 2012;78(3):271-279.

Sigmoid volvulus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 21, 2010. Accessed June 14, 2013.

Last Reviewed January 2014



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