Volvulus of the Colon - Symptoms, Causes, and Treatment

Introduction

Volvulus can develop in any portion of the intestine, hindering the blood supply to that particular area. The Volvulus of the colon is a potentially grave condition that necessitates immediate attention.

What Is Meant by the Volvulus of the Colon?

Volvulus of the colon is a frequently reported form of volvulus that is caused by unwanted coiling and warping of the colonic portion of the intestine. Therefore, it is widely known by the medical term colonic volvulus. It can involve any segment of the colon, but the sigmoid colon is the routinely affected area, followed by the cecal area. Colonic volvulus is widely reported in older patients.

What Is Volvulus?

• Volvulus is a specific medical condition that arises due to atypical winding or looping of the intestine around itself along with some portion of the mesentery. Mesentery is the tissue that renders support and stability to the intestine and acts as a medium to bind the intestine with the abdominal wall.

• When a confined loop is formed, it cuts off the blood supply to the specified area. Cells need a constant supply of blood to remain alive and to carry out their functions.

• Whenever blood supply to any area is significantly hampered, it results in the death of those cells. Likewise, the cells and tissues within the loop confinement will starve and eventually die out.

• It is an alarming condition and requires instant attention and treatment. Otherwise, it can be life-threatening. Volvulus can develop anywhere in the intestine and is differentiated based on the location in which it is formed.

What Are the Causes That Lead to the Development of Colonic Volvulus?

Certain deviations in the normal structure and anatomy of the colon reflect in the form of a volvulus. These variations can be inborn or developed later in life. Some of the prominent anatomical variations that could give rise to volvulus include the following:

• Extended colon.

• Colon not fixed to the underlying tissue.

• Abnormal gluing of colon segment as a result of surgical procedures, infections, or trauma.

• Inadequate connection with the mesentery.

• Scar formation in the colon segment following surgery or impact.

• Freely movable colon segment.

• Abnormal rotations in the intestine.

• Faulty attachment of the intestinal segment with the support structure.

Apart from the above-mentioned anatomic variations, there are certain other conditions that could give rise to volvulus formation. Some of them include the following:

• Persistent constipation (difficulty in excreting feces).

• Hirschsprung disease.

• Chagas disease.

• Regular laxative (enema) use.

• Surgeries involving the abdominal areas.

• Megacolon (abnormal colon enlargement).

• Practicing a diet that is very rich in fiber.

• Late pregnancy.

• Neurological disorders.

• Bedridden conditions.

• Persistent coughing.

• Mental disorders.

• Colonoscopy (procedure to get a clear view of the colon).

• Myopathy (disorder affecting the muscles and their functions - Duchene muscular atrophy).

What Are the Different Types of Colonic Volvulus?

Colonic volvulus can be categorized into different classes based on the area where the loop or twist develops.

• Sigmoid Volvulus: It is the commonest form of colonic volvulus in which the loop develops in the sigmoid colon region resulting in volvulus formation.

• Cecal Volvulus: When the intestinal winding happens in the ascending portion of the colon and adjoining cecum area, it gives rise to the cecal volvulus.

• Volvulus of Transverse Colon: It is less frequently encountered when compared with the other two categories.

What Are the Symptoms Associated With the Volvulus of the Colon?

Symptoms of colonic volvulus develop all of a sudden.

• Constipation.

• Abdominal fullness (bloating).

• Stomach ache.

• Vomiting.

• Nausea.

• Presence of blood in the fecal matter (bloody stool).

• High-degree fever.

• General weakness and fatigue.

• Palpitation (raised heart rate).

• Pallor.

• Dizziness.

• Loss of consciousness.

• Difficulty in flatulence (passing gas).

How Is Colonic Volvulus Diagnosed?

Detailed medical history and clinical findings are mandatory to arrive at a diagnosis. Physical examination and appropriate investigative tests are also suggested to clear the path to the final diagnosis. Physical examination reveals tenderness in the abdominal area, abnormal abdominal sounds, and distension. Diverse investigative tests and procedures are undertaken to rule out other related conditions and disorders. Routinely performed tests include the following:

• Blood Tests: These aid in detecting signs of infection or shock.

• Fecal Examination: It reveals the presence of blood cells and possible signs of infection.

• X-rays: Enlargement of the colon can be detected using conventional X- rays.

• Computed Tomography (CT): A CT can clearly depict the exact location of the colon distortion. In addition, it aids in checking out ischemic (due to compromised blood supply) damage in the bowel.

• Contrast Enema:Radioactive agents, preferably barium, are administered as an enema to produce a contrast radiographic image. However, it should be used very cautiously as it can worsen the condition in case of perforation.

• Flexible Sigmoidoscopy: It is a crucial investigative technique that facilitates the confirmation of diagnosis. It comes up with a clear picture of the volvulus.

• Laparoscopy: Though it is performed for the diagnosis, it is a bit of an extensive and invasive technique. Hence suggested only when other techniques lose the battle.

What Are the Different Treatment Interventions Available for Colonic Volvulus?

Treatment modalities largely depend on the time of diagnosis, site, and extent of the twist.

• Detorsion: The primary focus is to relieve (untwist) the winded segment, thereby reviving the blood flow to that segment. Preferably this reduction is made with the assistance of a sigmoidoscope. Once the blood flow is completely revived, careful monitoring is mandatory to check for areas of tissue damage. A major concern with the detorsion procedure is the re-occurrence of the volvulus.

• Intestinal Resection: If the twist cannot be relieved with the available techniques, then surgical elimination of the twisted area is initiated immediately to reinstate the blood flow. All the areas of necrosis (cell death) are removed, and the leftover healthy ends of the colon are approximated and stitched to bring back the blood supply. This kind of procedure offers notable success rates.

What Are the Potential Complications That Arise From Colonic Volvulus?

The success of colonic volvulus lies in timely diagnosis and instant treatment. In the absence of prompt treatment, it has the potential to progress into grave complications that can endanger a person's life. Possible complications include the following:

• Sepsis.

• Secondary peritonitis.

• Intestinal perforations.

• Malabsorption syndrome.

Conclusion

Volvulus of the colon is a medical exigency that demands immediate attention and treatment. Timely diagnosis greatly influences the treatment strategy and success rates. However, it can be effectively dealt with if diagnosed at the very right time.