Volvulus syndrome refers to a group of intestinal obstruction symptoms caused by the twisting and entanglement of the terminal ileum and sigmoid colon. It can lead to impaired intestinal circulation and partial or complete closure of the intestinal lumen, resulting in closed-loop intestinal obstruction. This syndrome primarily occurs in middle-aged and elderly individuals, most commonly in those over 45 years old, with a higher incidence rate in males than females. Cecal volvulus and transverse colon volvulus are extremely rare.

bubble_chart Etiology

The cause of the disease is unknown and may be related to anatomical variations. Specifically, both the terminal ileum and the sigmoid colon have excessively long mesenteries, with one end firmly fixed to the posterior abdominal wall. This creates conditions where a segment of the intestine is prone to rotational movement. Due to actions such as turning over and the gravitational force of accumulated contents in the intestinal lumen, one segment of the intestine can become twisted around another, leading to mutual entanglement that tightens progressively and cannot resolve spontaneously. In severe cases, strangulated intestinal obstruction may occur. Cohn et al. suggest that the formation of a volvulus requires two elements: ① an excessively mobile segment of the colon within the abdominal cavity; ② fixed points of the intestinal segment must be close enough to serve as a primary focus for potential volvulus. Others believe that chronic constipation and poor bowel habits may act as predisposing factors for sigmoid volvulus.

bubble_chart Pathological Changes

Intestinal volvulus can lead to increased intraluminal pressure, and sustained high pressure can injure intestinal blood circulation, potentially resulting in strangulated intestinal necrosis. It has been reported that among five patients with this condition, four were found to have necrotic intestinal segments during surgery, while one had segments that appeared brown-black. When the twisted and strangulated colon becomes excessively distended by a large amount of gas, perforation may occur. Once strangulated obstruction develops, in addition to fluid and plasma loss, toxic substances from the strangulated intestinal loop can become life-threatening. Intestinal obstruction can also cause severe metabolic disturbances and imbalances in water and electrolyte levels.

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This condition exhibits the typical clinical manifestations of volvulus and intestinal obstruction, with an acute onset and rapid progression. Patients experience paroxysmal severe colicky pain, abdominal distension, and fullness in the middle and lower abdomen, along with cessation of defecation and flatus. After the intermediate stage (second stage), nausea and vomiting may occur, with vomitus consisting of gastrointestinal contents. If strangulation develops, the aforementioned symptoms intensify, and in severe cases, necrosis and perforation may lead to diffuse peritonitis, toxic shock, and signs of fluid-electrolyte imbalance.

bubble_chart Auxiliary Examination

Examination reveals abdominal distension or visible intestinal loops, with abdominal tenderness most pronounced at the affected site. Percussion and auscultation show tympanitic sounds, and high-pitched borborygmi and splashing sounds may be heard in the early stage, while borborygmi diminish or disappear after the intermediate stage [second stage]. Digital rectal examination often shows an absence of feces in the rectal ampulla. When strangulation or perforation occurs, signs of peritoneal irritation may appear.

X-ray examination may reveal displacement of the sigmoid colon and small intestine, manifested as dilated and distended colonic loops located in the right lower abdomen or right flank, while the left abdomen shows a group of distended small intestine shadows.

bubble_chart Diagnosis

All patients with acute intestinal obstruction should be considered for the possibility of this syndrome, and X-ray examination can confirm the diagnosis. However, it needs to be differentiated from intussusception, mechanical intestinal obstruction, fecal impaction, and tumors.

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Due to the tendency of volvulus to recur and its potential to cause strangulation and necrosis, leading to diffuse peritonitis, toxic shock, and severe metabolic disturbances resulting in death, early surgical intervention is necessary once diagnosed.

Experiments have shown that antibiotics can prolong the life of animals with experimentally induced strangulated intestinal obstruction. However, the efficacy of antibiotics in human intestinal obstruction has not been clearly proven. Some reports indicate that for patients with uncomplicated symptoms who undergo surgery within 24 hours, the mortality rate is approximately 1%. In contrast, the mortality rate for those with intestinal gangrene can be as high as 4.5–31%.