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Volvulus

Emergency evaluation of obstruction and ischemia caused by twisting of the bowel around its own axis.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Volvulus?

Volvulus is the obstruction of both lumen and vascular flow that results when the bowel twists around the mesenteric axis. The sigmoid colon is most commonly affected (60-75%), followed by cecal volvulus. Sigmoid volvulus is more common in elderly, institutionalized patients with a long, hypermobile sigmoid mesocolon, while cecal volvulus is more frequent in younger patients.

Bowel wall ischemia develops rapidly; in late cases gangrene and perforation are inevitable. Sigmoid volvulus produces a characteristic 'omega' or 'coffee bean' sign on plain radiography, while cecal volvulus appears as a dilated bowel loop in the right lower quadrant.

In sigmoid volvulus, endoscopic decompression (advancement of a tube via sigmoidoscopy) is the first intervention; elective sigmoidectomy is planned in recurrent cases. Cecal volvulus requires surgery.

Symptoms

Sudden severe abdominal pain and distention
Cessation of gas and stool (closed-loop obstruction)
Nausea and vomiting
Increase in bowel sounds followed by their cessation
Sigmoid volvulus: pressure and fullness in the left lower quadrant
Fever, tachycardia and signs of peritoneal irritation in late stage

Risk Factors

Older age and elongated sigmoid colon
Chronic constipation and long-term laxative use
Neurological diseases and prolonged bed rest
Hirschsprung's disease (in children)
Pregnancy (increased cecal mobilization)
Previous abdominal surgery and adhesions

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden severe abdominal pain with cessation of gas
  • Progressive abdominal distention
  • Fever with signs of peritoneal irritation
  • Abdominal complaints in the high-risk patient group (elderly, institutionalized)
  • Recurrent symptoms in a patient with previous diagnosis of volvulus

Treatment Methods

01
Sigmoid volvulus: tube advancement by sigmoidoscopy (endoscopic decompression) with 80% success rate
02
Elective sigmoid resection after endoscopic procedure: planned to prevent recurrence
03
In suspected gangrene/perforation: emergency Hartmann procedure
04
Cecal volvulus: right hemicolectomy is the standard treatment
05
Cecopexy (suture fixation): an alternative in morbid patients; higher recurrence risk
06
Pre-operative nasogastric decompression and fluid resuscitation

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.