A volvulus is a rare health condition that causes abnormal twisting of the gastrointestinal tract, mainly involving different parts such as the stomach, large intestine or small intestine. A loop of intestine knots itself and can cause a lot of pain. And, this obstruction may result in serious medical complications. Volvulus should be diagnosed and treated at an early stage. The twisting leads to bowel obstruction that can put barriers on the blood supply to other areas of the bowel. The symptoms of volvulus range from severe abdominal pain to vomitting. And, the severity is different from person to person depending on the type of volvulus and the patient's medical history. The onset of symptoms are rapid in this condition. Risk factors of volvulus include birth defects, enlarged colon, pregnancy and persistent problem of constipation.
This is a medical emergency that requires immediate surgical treatment and shouldn't be ignored or untreated. If not treated on time, the areas of the bowels that are not getting enough blood will start dying. Volvulus of the small intestine usually affects newborns and children. In adults, volvulus of the small intestine is extremely rare. Sigmoid volvulus is more common among adults. To dig more into it, Onlymyhealth editorial team spoke to Dr. Vipulroy Rathod, Consultant Gastroenterologist & Endoscopist at Bhatia Hospital, Mumbai, about the types, symptoms, causes, diagnosis and treatment of volvulus.
Volvulus can lead to bowel obstruction which can cause fever and severe pain and that makes it a medical emergency. It restricts the vascular supply to the gut, so you need to get treated as soon as possible. There are 4 types of volvulus, they are gastric volvulus, midgut volvulus, cecal volvulus and sigmoid volvuli. And, according to Dr. Vipulroy, the two main types of volvulus are:
1. Gastric volvulus
Gastric volvulus occurs when the stomach twists atleast 180 degrees and then leads to obstruction just like in intestinal twisting leading to obstruction of the bowel. Patients with gastric volvulus may also result in a condition called Borchardt’s triad. The triad signs are sudden and can trigger pain, uncontrollable vomitting noises without actually doing it and a risk of passing out a nasogastric tube through the to the gut.
2. Sigmoid volvulus
Sigmoidal volvulus is one of the most common volvulus of gastrointestinal tract, involving the large bowel. These patients often experience abdominal bloating, constipation, nausea and vomitting. There is severe lower left side abdominal pain in this type of volvulus. In adults, causes of a sigmoid volvulus are mainly an enlarged colon, abdominal surgery, injury, or an infection or Hirschsprung's disease. Abdominal radiograph can diagnose this type of volvulus.
Other two very rare types of volvulus are:
3. Midgut volvulus
Midgut volvulus is the type that usually occurs in newborns. In midgut volvulus, the infant might be fine for a period of time but can develop this condition gradually with the main symptom, i.e sudden vomitting. There is a chance of tender abdomen and it gets filled with the fluid produced in the bowel called lumen, which results in swelling. Patients with MV require a fluoroscopic contrast examination, which is a spiral appearance test of the bowel. Other imaging tests include ultrasound and CT scan that can show everything in detail along with surrounding areas. And, a Ladd surgical procedure is done to treat midgut volvulus.
4. Cecal volvulus
Cecal volvulus occurs mostly due to lack of thorough peritoneal fixation and abdominal adhesions. This type of volvulus gives rise to a major symptom of a distended abdomen along with vomitting and nausea. Almost every patient with CV has an abnormally twisted cecum that causes disturbance in the gastrointestinal areas. This is a rare form of intestinal obstruction and is totally different from gastric and sigmoid volvulus.
The symptoms of volvulus appear suddenly and severely, so people usually go straight to the emergency room for prompt evaluation. Sometimes, a child may experience periods when they have volvulus symptoms and periods when they are symptom-free. In these cases, the child may have intermittent volvulus, a form of the condition where the symptoms reoccur periodically but go away on their own. These volvulus signs do not occur suddenly but start happening since a long time. So, one needs to pay attention and take care of their health. As per Dr. Vipulroy, the main symptoms of volvulus are:
- Abdominal pain
These were the symptoms that the adults experience. On the other hand, infants with volvulus might have to go through the below listed signs:
- Sudden crying
- Pain in legs
- Rapid heart beat
In infants, volvulus of the small intestine often occurs due to malrotation. Malrotation happens when there is a problem with intestinal formation, which results in settling in the wrong location in the abdominal area. This can lead to blockage or twisting of the intestines. Redundant intestinal tissue and constipation can also become a cause behind volvulus. Other causes of volvulus include chronic constipation, pregnancy and age is also one of the factors.
Dr. Vipulroy said, "Usually, the patients land up in emergency with volvulus symptoms. Then, an endoscopic evaluation or a CT scan with oral contrast is done by the doctor, as sometimes an endoscopic diagnosis can cause gastrointestinal perforation." CT scan can give a complete picture of the surrounding areas also. Prompt diagnosis of volvulus can help lead to early successful treatment and faster recovery. If a person experiences any symptoms of having a volvulus, the doctor firstly has to do a physical examination and note everything down about their medical history. Some other tests for volvulus diagnosis include X-rays and blood tests. If not treated on time, volvulus can lead to life threading complications such as sepsis and abdomen infection.
This is a mechanical health problem and not a functional one, so the treatment is also given mechanically. There are endoscopic fixation as well as surgical treatments for volvulus. Volvulus needs immediate medical response or proper treatment and in most of the cases there is a requirement of surgery. During this surgery, the procedure is basically done to correct the volvulus by making a small and simple incision in the abdominal wall, and near the internal obstruction. This incision is made to untwist the twisted part. Then, the doctor will also restore blood flow to the bowel areas that might have gotten affected by the volvulus and see if any part had died. The surgeon might also remove the dead part from your body. The same can be done in a laproscopic surgery. Sometimes, this procedure might also leave a person’s appendix in a different area. If this happens, the surgeon might also remove the appendix.
So, these were the types, symptoms, causes, diagnosis and treatment of volvulus Dr. Vipulroy Rathod. If you experience any of the above symptoms of volvulus, then you need to consult a gastroenterologist. Early diagnosis and treatment can help in preventing serious health complications. Do not let it get to the stage when there is tissue damage in the bowel areas. Dr. Rathod mentioned, "Talk to your doctor for diagnosis of the underlying cause of the abdominal pain to avoid any further complications."
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