In medicine, a volvulus is a rotation of a section of the digestive tract around its own axis. As a result of the rotation, the supplying blood vessels of the affected section are pinched and the oxygen supply is reduced or completely interrupted. The consequences can range from intestinal obstruction to death of the affected area (intestinal gangrene).
Of the appendix, the caecum, and the rearmost part of the Colon, the Sigmoidum, are most common of Bowel twist affected. in the Small intestine the volvulus is mostly caused by a disturbance in the rotation of the small and large intestines Embryonic development conditional, the so-called malrotation. Their frequency is 1:500 Live births and is twice as common in boys.
Connection to the ileus
An ileus is known colloquially as a bowel obstruction. The intestinal obstruction disrupts the natural passage through the intestine. It is provoked either by a mechanical obstacle (mechanical ileus) or by intestinal paralysis (paralytic ileus). The ileus that is triggered by a volvulus is a typical mechanical intestinal obstruction. There is severe, usually sudden, abdominal pain. Depending on the level of the intestinal obstruction, the ileus is the first to be noticed by vomiting or the lack of stool. When listening to the abdomen, the ileus is presented by a volvulus with typical so-called superscript bowel noises. A typical mirror formation is impressive in the X-ray abdomen overview. The intestinal loops are also over-inflated. In sonography, a volvulus causes a typical pendulum peristalsis in mechanical ileus. The intestine works against the twisting that disturbs the natural peristalsis. The movement of the bowel is then returned in the opposite direction. In the case of mechanical ileus, surgery is usually essential to prevent the intestinal loops from dying off.
Read more on the subject at: Recognize intestinal obstruction in babies
The most common and famous root cause for the volvulus is that Malrotation, so one incorrect bowel rotation in the Embryonic development.
Also Inflammation of the bowel can lead to the volvulus, these can bacterial, chemically, allergic or through radiation be conditional. Another possible trigger is Colon cancer or adhesions in the intestines. After a perforated Appendicitis it can become so-called Brides (These are connective tissue adhesions that have arisen in the course of an operation), which can also promote the occurrence of a volvulus.
People suffering from the hereditary disease Cystic fibrosis who are ill also have a higher risk of developing a volvulus, as the tough intestinal contents can only be transported inadequately.
Symptoms of an acute volvulus include cramping abdominal pain, a distended stomach, Vomit (greenish), Diarrhea (partly bloody), Peritonitis and shock.
A chronically relapsing volvulus manifests itself in a reduced intake of food components (malabsorption), unspecific abdominal pain and a Constipation in the child.
To Diagnosis Above all, imaging procedures serve as one X-ray of the abdomen (possibly with contrast agent) or a Ultrasonic. This shows a massive Overinflation of the previous intestinal sections.
At the volvulus des Sigmoidum there is the so-called Coffee bean signwhere bloated ascending loops of intestine lie close to a descending loop of intestine and both look like a coffee bean together.
Is the intestine already burst (perforated) is found lots of free air around the X-ray image/ Ultrasound.
In the case of volvulus in newborns or also chronic courses, the diagnosis is much more difficult, since in these cases the x-ray image is usually normal.
CT image of the abdomen
An X-ray abdomen overview usually shows specific information depending on the location of the volvulus. In a CT abdomen overview of the abdomen, however, the unspecific can be seen "Whirlpool" mark, or “whirl sign” for short. This sign occurs when a structure becomes twisted, as is the case with the intestinal volvulus. The intestine rotates around its tissue suspension together with the vessels inside. This creates the “vortex” on the CT image. The vertebra can also be seen in the event of an ovarian twist.
Sonography of the volvulus
With a volvulus, the stomach and the Intestinal sections inflated and dilated before twisting. The mobility of the intestinal loops is restricted. The "whirlpool" symbol can also be seen in the abdominal ultrasound scan of an intestinal volvulus. The upper supplying vein usually wraps around the upper artery. The delicate blood flow situation can easily be shown in the sonography with the help of a Doppler examination, in which the direction of blood flow can be traced.
Acute volvulus: The acute volvulus is a emergency, The aim of therapy is that Restoring the correct situation as quickly as possible the intestinal sections. If a volvulus is suspected, an operation is prepared and performed immediately, as the time of the Undersupply of the intestine is decisive for its prognosis and only possible with quick action Die can be prevented.
In the operation, the bowel is first turned back and the adequate blood supply tested and ensured. If the intestinal sections are intact, they may be fixed in place to prevent another incident. Intestinal sections, but they do too badly damaged due to insufficient supply or because they may have burst (perforated) away become. For this purpose, the relevant section is cut out and the two open ends of the intestine are connected to one another.
The exception is the therapy of Volvulus of the SigmoidumAn attempt can first be made here via one introduced into the anus probe with the help of Enemas rotate the bowel back into position. If this fails, an operation as described above is carried out here too.
Chronic volvulus: Again, the therapy of choice is the one surgerySimilar to acute volvulus, attempts are made to turn the bowel back into its correct position and fix it there.
The prognosis depends on the Length of the affected section of the intestine and the Time of insufficient supply.
If large parts of the small intestine have to be removed, there is a risk of it developing Short bowel syndrome. These are digestive and food intake disorders as a result of the shortened intestinal passage, which under certain circumstances can lead to lifelong complications.
A clear measure for Prevention of bowel twisting does not exist, but you can rely on your Gut health respect and thus reduce the risk. Above all, this includes one healthy eating with lots of fruits and vegetables, as well as fiber. Also should be on a adequate hydration be respected. Most suitable are drinks with little to no sugar, such as water or tea. Also, regular exercise and Sports keep the intestines fit, as these stimulate digestion.