Volvulus refers to the pathological twisting of a section of intestine around its axis. It is therefore also commonly referred to as intestinal entanglement. This twisting or twisting leads to an undersupply of blood in the affected section of the intestine. This can result in an intestinal obstruction or the death of the part of the intestine (intestinal gangrene).
What is a volvulus?
If certain sections of the intestine are knotted or intertwined, this is an intestinal entanglement. This condition can be life threatening. Intestinal entanglements are often congenital, since the natural development of the intestine was already disturbed in the womb. For cruciate ligament tear (clt), please visit nonprofitdictionary.com.
The twists that were necessary before birth were then not carried out by the intestines or only carried out incorrectly. Parts of the intestine rotate around the mesentery stalk. This carries the afferent or efferent blood vessels. This change in the position of the intestine can lead to a partial or complete blockage of the intestinal tube. There are two main forms of intestinal torturing. During invagination, one part of the intestine is invaginated into another part of the intestine.
The invagination occurs longitudinally and causes blood stasis and swelling. It leads to intestinal obstruction. The second major form of intestinal entanglement is axis rotation. A loop of intestine rotates up to 180 degrees, wraps itself around another loop and thus cuts off the blood supply. Due to an intestinal obstruction, the intestine can no longer fulfill its tasks. It can lead to an undersupply of vital organs and a life-threatening condition.
A well-known cause of bowel tangles is malrotation, a faulty rotation of the small and large intestines in human prenatal development. Children are more likely to experience volvulus, and this is an emergency that requires immediate attention.
Babies in their first year of life are most commonly affected. Intestinal infections can also cause intestinal obstruction. Intestinal inflammation is caused by bacteria, chemicals, radiation, an allergic reaction or an immune reaction. Colon cancer can also be a triggering disorder. Adhesions are also one of the causes of volvulus.
These are connective tissue-like strands between sections of the intestine that normally have no connection. The exact causes of these adhesions in the intestine are not known. It is suspected that it could be a reaction to a foreign body, a previous inflammation or even to operations. Surgery itself can also cause intestinal obstruction.
Symptoms, Ailments & Signs
Intestinal obstruction is more common in babies and young children than in adults. Prenatal forms of volvulus are also observed. Typical symptoms are constipation, colicky abdominal pain, flatulence, nausea and vomiting. Depending on the site of ingestion, vomiting of bile and feces may occur.
After vomiting, the symptoms temporarily improve. The symptoms often even temporarily disappear completely. However, this is followed by constipation, vomiting and bloody stools. A distinction can also be made between acute and chronic volvulus. In the case of acute intestinal obstruction, the symptoms of vomiting, bloated upper abdomen and severe colicky abdominal pain appear suddenly.
In severe cases, shock or peritonitis often occur. Chronic relapsing (recurring) volvulus is more likely to be characterized by nonspecific abdominal pain and chronic constipation. Furthermore, the body is undersupplied with nutrients because their absorption in the intestine no longer works properly. Due to malnutrition, the organism becomes weaker and weaker.
However, there can also be symptom-free intervals between the individual flare-ups. In severe cases, the supply to the intestines is often so limited due to the interruption in blood flow that the affected section of the intestine dies. Then the intestinal entanglement developed into an intestinal obstruction. In this situation, there is a high risk of death due to intestinal perforation and bacterial infection of the abdomen (peritonitis). An intestinal entanglement can usually only be treated surgically.
Diagnosis & History
The symptoms of intestinal obstruction are sudden, cramping abdominal pain, a bloated upper abdomen, bilious-greenish vomiting and diarrhoea-like, bloody stools. The upper abdomen is sensitive to pressure, while the lower abdomen is more sunken.
The diagnosis is difficult for the doctor. It is usually made after symptoms appear, a thorough physical exam, and imaging studies. Sometimes a correct diagnosis can only be made during an operation. Imaging tests are x -rays and ultrasound.
If there is an entanglement of the intestines in the back of the large intestine, the massive overinflation of the part of the intestine can be seen on the x-ray with a kind of coffee bean sign. The overinflated part of the intestine then often has the contour of a coffee bean. The course of an intestinal entanglement is life-threatening, as it leads to life-threatening intestinal obstruction and must therefore be treated as an emergency.
A volvulus can cause serious complications. An entanglement of the intestines initially causes severe abdominal pain, which increases in intensity as the disease progresses and significantly restricts those affected in everyday life. Great complications are to be expected if the entanglement leads to an undersupply of a section of the intestine.
This can lead to the dying off of the part of the intestine or to an intestinal blockage. Accompanying this, peritonitis often occurs, which later spreads to other internal organs and quickly develops into a life-threatening condition. If the volvulus is not treated immediately in intensive care, there is a risk of circulatory shock.
In the worst case, an intestinal entanglement can be fatal. The treatment also comes with risks. An operation always carries the risk of injuring parts of the intestine or of infection. Injuries to the intestinal walls can lead to functional disorders that may remain permanent.
Sometimes a colostomy needs to be placed, which carries the risk of hernias and injuries. Finally, the administration of medication can lead to side effects and interactions.
When should you go to the doctor?
In the case of abdominal pain, irregularities in the abdomen, nausea or vomiting, the cause of the symptoms must be clarified. If a clear alleviation of the disorders is already evident after a short time, it is often a matter of a short-term health impairment. A doctor is not required if there is a permanent freedom from symptoms. If the symptoms reappear, persist for a long time or are characterized by an increasing character, a doctor must be consulted. There is a need for action, especially in the case of a chronic course of the disease, since entanglement of the intestine can lead to serious health developments.
Flatulence, constipation or a strong feeling of pressure in the abdomen indicate irregularities that should be examined. If blood can be felt from the anus when going to the toilet or if there are sudden health problems, a doctor should be consulted immediately and as quickly as possible. In the event of an intestinal entanglement, there is a potential risk to one’s own life.
For this reason, rapid and unexpected health problems should be discussed with a doctor. Mobility disorders, hypersensitivity to pressure influences in the stomach or intestines and sweating are warning signs of the human organism. Sudden circulatory changes, irritability, or a rapid decrease in exercise capacity need to be evaluated and treated.
Treatment & Therapy
In order to treat an intestinal entanglement, it is necessary to bring the relevant section of intestine back into its original position as quickly as possible. This can only be done with an operation. Time is of the essence in such operations, as the cut off of the blood supply to the affected section of intestine quickly leads to the death of the tissue.
The twisted part of the bowel is fixed during the operation to prevent repeated twisting. If the affected part of the intestine is already so damaged that a restoration of the function can no longer be expected, parts of the damaged tissue are removed. Under certain circumstances, it may be necessary to place an enterostomy (artificial bowel outlet).
In a more conservative approach, the volvulus is initially decompressed acutely. A flexible colonoscope is used. It is important to determine whether the intestine is still vital or not. If the intestines are still alive, the first step is to examine the anal canal. After the examination, an intestinal tube is placed. Reduction of the volvulus is then indicated by a noisy discharge of gas and stool. The type of therapy always depends on the extent to which the blood flow in the intestine or the affected section of the intestine is impaired.
Proper prevention of a bowel obstruction means maintaining good gut health. This includes a healthy diet with valuable fiber, lots of fruit and vegetables. The acid-base balance should be balanced.
It is also important for the intestines to take in enough liquid – preferably water or drinks with low sugar levels. Food that is difficult to digest should be avoided. Regular exercise is also important for a healthy gut.
If the bowel obstruction (volvulus) has been treated, no medical follow-up is required. After the recovery phase, the patient is operational. The length of the recovery period depends on the age of the person affected. Exercise is important during recovery, but not physical exertion. A change in diet reduces the risk of recurrence.
Sufficient fiber combined with vitamins and minerals keep the intestines healthy. The daily increase in liquid in sufficient quantity supports the intestinal activity. Hasty eating is unhealthy. Several smaller portions spread over the day are recommended. Don’t forget the daily physical activity.
Part of the intestine had to be removed during the operation. An artificial anus was necessary. This enterostomy is removed after some time. Recovery after the first part of the operation takes longer. Medical aftercare includes dealing with the stoma.
The medical staff cleans the entrance daily. After a few days, the patient takes over these actions. The intestine has regenerated and the artificial outlet is removed. After the wound has healed, no further medical measures are necessary. A change in diet is also required here. The necessary steps are explained by the nursing staff as early as the “stoma phase”.
You can do that yourself
Acute volvulus requires immediate medical attention. In the event of stomach pain, discomfort and other signs of intestinal obstruction, the emergency services should be alerted. The body should be kept still until the doctor arrives.
Acute volvulus must be treated surgically to prevent the affected section of the intestine from dying. After the operation, the priority is rest and protection. If necessary, the diet must be changed. In the case of chronic volvulus, an operative procedure is also necessary. The patient must then follow the doctor’s instructions and, for example, avoid sporting activities. Medical intervention is indicated for volvulus of the sigmoid. Then again, rest and a change in lifestyle apply.
In addition to regular physiotherapy, which can be carried out by the patient at home, sufficient fruit and vegetables should be consumed. The menu should also consist of high-fiber foods that are easy to digest at the same time. A nutritionist can create a suitable plan. It is important to drink enough liquid. Water and isotonic drinks have proved their worth. Physical activity is also important for the health of the gastrointestinal tract.