Colonic Volvulus

What is colonic volvulus?

Colonic volvulus occurs when the colon twists around the tissue that holds it in place, called mesentery. The twisting causes intestinal obstruction.

The most common types of colonic volvulus are

• sigmoid volvulus, which is twisting of the sigmoid colon
• cecal volvulus, which is twisting of the cecum and ascending colon

How common is colonic volvulus?

Colonic volvulus is uncommon in the United States, causing less than 5 of every 100 cases of intestinal obstruction.¹⁸

Colonic volvulus is more common in Africa, the Middle East, India, Russia, Eastern Europe, and South America. In these regions, colonic volvulus causes 13 to 42 of every 100 cases of intestinal obstruction.¹⁸ Experts think this condition is more common because people in these regions are more likely to eat a high-fiber diet, which is a risk factor for colonic volvulus.¹⁹

Who is more likely to get colonic volvulus?

Colonic volvulus is most common in adults between the ages of 50 and 80. Sigmoid volvulus is more common in men, while cecal volvulus is more common in women.²⁰

Sigmoid volvulus is more common in older adults who

• have chronic constipation
• have mental health or nervous system disorders
• have chronic medical conditions
• live in nursing homes or psychiatric facilities

What are the complications of colonic volvulus?

Colonic volvulus can cause life-threatening complications. The twisting of the colon can lead to

• intestinal obstruction
• dehydration
• lack of blood flow to the blocked part of the colon and death of the blood-starved tissues
• a perforation, or hole, in the wall of the intestine
• peritonitis, an infection of the lining of the abdominal cavity
• sepsis, a serious illness that occurs when the body has an overwhelming immune system response to an infection
• shock

What are the symptoms of colonic volvulus?

If you have symptoms of colonic volvulus or its complications, seek medical help right away.

Symptoms of colonic volvulus may include

• bloating
• constipation
• cramping and pain in the abdomen
• nausea and vomiting

Symptoms of complications of colonic volvulus may include

• symptoms of infection, such as fever
• symptoms of shock, such as confusion or unconsciousness, a fast heart rate, pale skin, and sweating

What causes colonic volvulus?

Certain structural differences and risk factors may increase the chance of colonic volvulus.

Structural differences

Experts think that certain structural differences in the cecum and colon increase the chance of volvulus. For example

• the sigmoid colon may be longer than average
• the tissue that holds the sigmoid colon in place may allow it to move more than usual
• the cecum and the ascending colon may not be fixed in place and may move more than usual

Risk factors

The chance of colonic volvulus may be higher in people with certain conditions, such as

• chronic constipation
• frequent use of laxatives
• a high-fiber diet
• past abdominal surgery

Sigmoid volvulus is more common in older adults who have chronic medical conditions or disorders that involve the nervous system and mental health. Sigmoid volvulus is also more common among older adults who live in nursing homes or psychiatric facilities and spend long periods of time in bed.

In children, diseases such as Hirschsprung disease or Chagas disease can cause severe swelling of the colon, called megacolon, which can lead to volvulus.

The chance of cecal volvulus is higher in people who have had colonoscopy or laparoscopy and in women who are pregnant.

How do doctors diagnose colonic volvulus?

Your doctor will diagnose volvulus of the colon based on your symptoms and medical history, a physical exam, and medical tests.

Medical history

Your doctor will ask about your symptoms and any history of conditions that may be risk factors for colonic volvulus.

Physical exam

During a physical exam, your doctor may

• check for bloating of your abdomen
• press or tap on your abdomen to check for tenderness or pain
• use a stethoscope to listen to sounds within your abdomen
• check for signs of complications, such as infection or shock

Imaging tests

Doctors may use one or more imaging tests to check for volvulus of the colon. These tests may include

• x-rays, which use a small amount of radiation to create pictures of the inside of your body
• computed tomography (CT), which uses a combination of x-rays and computer technology to create images
• lower GI series, which uses x-rays and a chalky liquid called barium to view your large intestine

How do doctors treat colonic volvulus?

Doctors most often treat colonic volvulus with surgery.

Sigmoid volvulus

If you don’t have signs of damage to your colon, your doctor may use flexible sigmoidoscopy to examine your sigmoid colon and try to untwist the volvulus. If the procedure is successful, the doctor may plan surgery to remove the affected part of your colon. This surgery can prevent the volvulus from happening again. You typically have the flexible sigmoidoscopy and surgery during the same hospital stay.

If your colon is damaged or if the doctor can’t untwist the volvulus during flexible sigmoidoscopy, you will need surgery right away to remove the affected part of the colon.

Cecal volvulus

Doctors treat cecal volvulus with surgery. Most often, doctors will remove the affected part of the cecum and colon. In some cases, doctors may perform surgery to untwist the volvulus and attach the cecum to the wall of the abdomen to hold it in place.

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