Volvulus is a twisting of a GI tract segment often leading to bowel obstruction. The most common sites of volvulus are colon, both the sigmoid (left side) and cecum (right side). Volvulus in other areas of the GI tract, like the stomach, gallbladder and small bowel are rare. A volvulus is often caused by a “floppy” colon, or a colon not adhered to the inside of the abdominal wall. This causes it to “flop over” on itself and become twisted, much like a balloon animal.
Symptoms and diagnosis
The majority of patients with sigmoid volvulus complain of:
- Abdominal distension
- Vomiting (less common)
Some patients, particularly younger patients, may have on-and-off recurrent attacks of abdominal pain. The discomfort, and its disappearance, is due to spontaneous twisting and de-twisting of the colon. The diagnosis is often suspected based upon the symptoms and physical examination. The pain associated with sigmoid or cecal volvulus is usually continuous and severe. Intermittently, you will experience crampy pains and your abdomen is usually distended and firm.
Compromise of the blood supply to the twisted colon can lead to gangrene (the tissue starts to die). This results is widespread abdominal pain and sepsis, or severe body-wide infection. Fortunately, the majority of patients come to medical attention before they develop gangrene.
An abdominal x-ray or CT scan will confirm a volvulus diagnosis.
The goal of treatment is to prevent gangrene and to address the abnormality that led to the volvulus. An effective way to restore the blood supply to the colon is to untwist the volvulus. This is accomplished by advancing a flexible or rigid sigmoidoscope through the twisted segment. This may release the twisting, and stop the immediate danger. There is a high chance of the twist recurring; so surgery is usually still required.
A colonoscopy is not likely to untwist the colon; so surgery is required.
Surgery for treatment
When surgery is required, we perform it as open surgery, under general anesthesia. Your surgeon may attempt to secure the colon to your abdominal wall. This would prevent it from twisting again. Or he/she may need to remove that piece of the colon. If the colon has gangrene and is unhealthy, that segment will definitely need removal.