Gut Volvulus

A volvulus occurs when any part of the gut 'twists' on itself. This usually has two potentially disastrous consequences:

• The organ twists and the tube is twisted shut leading to bowel obstruction.
• The mesentery or base of the organ containing the blood supply is also twisted shut leading to ischaemia, necrosis and potentially perforation.

A volvulus usually occurs in the presence of an anatomic defect that renders the organ more susceptible to twisting. Any part of the GIT can be affected, but the sigmoid colon is by far the most common site involved.

Different parts of the gastrointestinal tract may be affected by a volvulus:

• Gastric volvulus:
  Usually occurs in the presence of a large hiatus hernia where most of the stomach is located in the chest cavity.
• Midgut / small bowel volvulus:
  Mostly seen in early childhood due to a embryological malrotation of the bowel.
• Sigmoid volvulus:
  Can occur if the sigmoid is very mobile with an elongated mesentery. People who are in longterm care facilities and certain population groups are more at risk.
• Caecal volvulus:
  This is a rare form of intestinal obstruction which occurs when the cecum detaches from the posterior abdominal wall and twists on itself. The cecum is located in the right lower abdomen at the start of the colon.

What are the related symptoms of volvulus?

Signs and symptoms of volvulus usually occur suddenly and can be severe. The symptoms may include:

• Tenderness and abdominal pain
• Vomiting
• Nausea
• Distended abdomen
• Bloody stool
• Constipation
• Shock

How is a volvulus treated?

Volvulus treatment depends entirely on whether the affected organ is still viable. If the organ is viable, it can be 'untwisted' and the underlying anatomical defect can be fixed to prevent future re-occurrence. Once necrosis has occurred, the patient may be toxically ill and very unstable. Surgery in this scenario is potentially lifesaving. During the surgery, Dr Cooper will resect the compromised part of the gut and perform a stoma (colon / small bowel opening onto the skin). Restoration of continuity (closure of the stoma) is left for a later date if the patient survives.