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Volvulus
Volvulus is an abnormal twisting or rotation of a loop of bowel on its self. It could occur any where down the gut.
In the stomach, it is called Gastric Volvulus. In the small intestine it is Intestinal Volvulus, in the beginning of the first part of the large bowel it is called Caecal Volvulus, along the middle of the large bowel it is Transverse Volvulus and at the end of the large bowel, before the rectum, it is called Sigmoid Volvulus.
Ileo-sigmoid volvulus or knotting is a form of volvulus commonly seen in Africa.
Sigmoid volvulus is by far the commonest, followed by caecal and then intestinal and transverse volvulus. Gastric volvulus is extremely rare.
Common to all volvulus is that the twist leads to obstruction of the lumen and blood supply to that part of the gut.
If this situation occurs for sufficient time, usually more than six hours from time of onset, that portion of the gut could die and become gangrenous (or rot). Volvulus is therefore a surgical emergency.
Volvulus accounts for about 10% of all causes of bowel obstruction. It can occur at any age, but mainly before age 5 and after 65years of age.
Volvulus is also common in those in nursing homes, prisons or any long term institution. Other causes or predispositions to having volvulus include:
• Consumption of large bolus of high fibre meals. This acts as a fulcrum on which the bowel twists
• Having a bowel with a narrow long mesentery (the part of the bowel where blood vessels pass to reach the main bowel)
• A very freely mobile gut
• For no apparent reason!
Plain X-rays of the abdomen, CT- Scan, and Barium studies are very good in confirming the diagnosis of this condition.
Where initial attempt to untwist the bowel is unsuccessful, like in the use of rigid tube and a pipe into the anus as in sigmoid volvulus, surgery may be required urgently.
Read about the various types of volvulus as well as access useful links below.
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