Content

Introduction

Volvulus is a medical term, which describes the twisting of the intestine on a structure, called the mesentery, which connects the intestine with the abdomen, holding it firmly anchored in place.

The consequence of the twisting is a narrowing of the intestine at the point of rotation and the compression of the blood vessels that feed it. To cause the compression or obstruction of the blood vessel, the force exerted by the twisting must be greater than the blood pressure present inside. The first blood vessel to be affected by the volvulus is the vein.

If the torsion is not surgically treated, venous ischemia (obstruction that prevents blood from continuing along the vein and causes it to return to the vessels of origin) or a perforation of the intestine can occur.

The volvulus is, therefore, a "medical emergency that requires urgent surgery to prevent the parts of the intestine lacking a sufficient supply of blood from being irreparably damaged (necrosis).

Small intestine volvulus usually occurs in infants and children, while it is rare in adults. In the latter, volvulus tends to occur in the colon.volvulus of the sigmoid or sigmoid) and in the "caecum. A twisting similar to that of the intestine can also occur in the stomach, and is called gastric volvulus. The assessment (diagnosis) of the volvulus is performed by radiography and computed tomography.

Symptoms

People affected by volvulus usually go to the emergency room immediately because the clinical manifestations (symptoms) appear suddenly and severely.

They include:

  • abdominal pain
  • bilious vomiting
  • nausea
  • distended abdomen
  • I made with blood
  • constipation
  • fever
  • state of shock

Additional signs and disturbances may appear in infants, including:

  • sudden bouts of crying
  • curl the legs towards the chest (movement that relieves pain)
  • drowsiness
  • fast breathing and heartbeat

Sometimes, a child may exhibit volvulus symptoms only at some times and at other times appear not to be in pain. In these cases, he may suffer from intermittent volvulus, a condition in which the complaints occur periodically, disappear on their own and then recur later.

Causes

The main cause of volvulus in children is malrotation The bowel is a problem present at birth (congenital) caused by a defect in rotation and fixation of the bowel during fetal development. Volvulus resulting from malrotation almost always occurs in the first few months of a child's life and equally in males and females. Some people with bowel malrotation may not have clinical manifestations throughout their life; others may have them in adolescence or adulthood.

Other less common causes of volvulus are:

  • colon longer than normal
  • Hirschsprung's disease, an "anomaly of" innervation of the colon present at birth
  • pregnancy
  • abdominal adhesions, particularly following surgery
  • chronic constipation
  • diseases of the nervous system
  • diabetes

The volvulus of the sigmoid and cecum occurs mainly in people between the ages of 30 and 70 and, in particular, in men.

Diagnosis

The rapid detection (diagnosis) of the volvulus allows the therapies to be carried out with the greatest probability of success and to obtain the best results. To ascertain the volvulus, the doctor inquires about the person's state of health over time (anamnesis) and carries out a medical examination.

It may also require investigations which include:

  • blood tests
  • search for blood not visible to the naked eye (occult) in the stool
  • radiography of the abdomen, if there is a volvulus, the x-ray of the abdomen shows it without difficulty
  • Abdominal CT scan, useful for studying the degree of severity of a volvulus, but not recommended for young people
  • flexible sigmoidoscopy, direct observation with an endoscopic instrument of the intestinal tract called sigma

Therapy

The volvulus requires immediate treatment and, almost always, surgery. The choice not to operate is made in case of slight bowel torsion or other factors such as the advanced age of the person or the state of health of her. The conservative treatment it involves decompression of the colon through organ repositioning maneuvers performed during a sigmoidoscopy or colonoscopy. In general, volvulus and intestinal blockage are more likely to recur after conservative treatment.

Surgery is chosen primarily based on the severity of the torsion or if conservative treatment has not been successful. During the procedure, the surgeon makes a small incision in the abdominal wall, close to where the torsion occurred. torsion and repositions the intestine to the correct position. Immediately afterwards, it restores blood circulation in the parts of the intestine where it was interrupted.In the event that a portion of the intestine has been without blood for too long and therefore an intestinal blockage or ischemia (death of the part of the intestine that no longer receives adequate levels of oxygen) has occurred, the surgeon removes the part Sometimes the tract of intestine to be eliminated is so large that it is impossible to make the extremities stick together. In this case, an opening is created in the abdominal wall, called ostomy.

Complications

A volvulus can be life-threatening if not treated quickly or it can cause complications that include:

  • severe blood infection (sepsis)
  • short bowel syndrome, a condition that causes malabsorption as a consequence of a "large surgical resection of the" small intestine for necrosis of the organ resulting from the volvulus
  • abdominal infection, known as secondary peritonitis

The mortality rate is 30-40% in people in whom the cecum volvulus is not treated quickly. Thus, the faster the treatment, the greater the chance that the volvulus will resolve positively.

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