Volvulus

December 22 22:03 2019 Print This Article

A volvulus – in this case occurring in childhood – is a twisting of the bowel with obstruction of the flow of material through the bowel, variable loss of blood supply, and possible tissue death. Gastric volvulus is defined as an abnormal rotation of the stomach of more than 180°, creating a closed loop obstruction that can result in incarceration and strangulation. It results in ischemia (loss of blood flow) and the accumulation of gas and fluid in the portion of the bowel obstructed.

Compromised blood supply to the involved segment, together with the increase in intraluminal pressure, leads to gangrene and perforation if unrelieved. Volvulus occurs most frequently in middle-aged and elderly men. The gastric dilatation is one part of the condition and the volvulus or torsion is the second part. It assumes an “upside-down” configuration. In this type, the pylorus and antrum are cranial to the fundus. A volvulus is a problem that can occur after birth as a result of intestinal malrotation. This type is more common in children. The bowel may become obstructed, and/or the blood supply may become decreased.

Volvulus is an abnormality that occurs while a fetus is forming in its mother’s uterus. The study and treatment of malrotation and volvulus have a long and intriguing history. Over the next 35 years, studies continued on intestinal rotation, and case reports of malrotation began appearing in medical literature, along with attempts at treatment and correction. Sigmoid volvulus is the most-common form of volvulus of the gastrointestinal tract and is responsible for 8% of all intestinal obstructions.

Sigmoid volvulus is particularly common in elderly persons and constipated patient. In the vast majority of cases, sigmoid volvulus is an acquired condition, resulting from elongation of the sigmoid loop and stretching of the sigmoid mesocolon. A distended transverse colon, however, has a convex inferior margin, with the double central wall extending ephalad, the opposite of sigmoid volvulus. Understanding the signs, prevention, and need for prompt treatment will help reduce the risk of mortality if your dog develops this problem.

Causes of Volvulus

The comman causes of Volvulus include the following:

  • The most common cause of gastric volvulus in adults is diaphragmatic defects.
  • Chronic constipation ( type of Constipation ).
  • Meconium ileus.
  • Hirschsprung disease.
  • Congenital bowel defects.
  • Situs inversus and asplenia (may be associated with biliary atresia).
  • Kidney abnormalities.
  • Agenesis of corpus callosum.
  • Malrotation of the bowel during fetal development may predispose infants to a volvulus, although a volvulus can occur in the absence of malrotation.
  • Volvulus that occurs later in life is most likely due to problems that have arisen either from an infection or from surgery.

Symptoms of Volvulus

Some sign and symptoms related to Volvulus are as follows:

  • Abdominal tenderness.
  • Vomiting green bile-looking material.
  • Constipation or difficulty expelling stools.
  • Sudden severe abdominal pain.
  • Abdominal distention.
  • drawing up the legs.
  • Rapid heart rate.
  • Rapid breathing.
  • Constipation or difficulty expelling stools.
  • Distended abdomen.
  • Nausea or vomiting.
  • Constipation.

Treatment of Volvulus

Here is list of the methods for treating Volvulus:

  • The definitive treatment of malrotation and intestinal volvulus is surgical correction.
  • Children may be started on IV (intravenous) fluids to prevent dehydration and antibiotics to prevent infection.
  • A tube called a nasogastric (or NG) tube may be guided from the nose, through the throat and esophagus, to the stomach to prevent gas buildup in the stomach.
  • Electrolytes are replaced aggressively.
  • Foley catheter placement may be appropriate, especially in older children.
  • If the twist is incomplete, spontaneous reduction may occur, or may be induced by insertion of a rectal tube via the sigmoidoscope.
  • An abdominal operation is needed to untwist the volvulus.