Medicines for Volvulus

What it is

A volvulus is a twisting of a loop of the bowel around itself (and the tissue that anchors it). This is serious for two reasons: the twist blocks the bowel (causing a bowel obstruction), and it can also cut off the blood supply to the twisted segment, which, if not relieved, leads to the bowel tissue being damaged and dying, and potentially bursting — a life-threatening situation. Volvulus most commonly affects parts of the large bowel — particularly the sigmoid colon (the lower part, sigmoid volvulus, more common in older and frail people, or those with chronic constipation) and, less commonly, the caecum (caecal volvulus). It can also, importantly, occur in babies and children due to a condition present from birth where the bowel is not properly fixed in place (malrotation with midgut volvulus), which is a paediatric emergency. Symptoms include sudden or rapidly worsening severe tummy pain, a swollen, distended tummy (which can become very bloated), vomiting, and being unable to pass stool or wind — the features of a bowel obstruction, but often coming on more acutely. Because a volvulus can quickly threaten the bowel's blood supply, it is a medical emergency needing urgent assessment and treatment.

How it is treated

A volvulus is a surgical emergency needing urgent hospital assessment and treatment, as prompt action can relieve the twist and save the bowel before its blood supply is critically compromised. The diagnosis is confirmed with examination and imaging (X-rays, and commonly a CT scan, which can show the characteristic twisted appearance). Treatment depends on the type and on whether the bowel is still healthy. For a sigmoid volvulus, if the bowel is not yet damaged, it can often be untwisted non-surgically using a flexible camera (a procedure that decompresses and untwists the bowel, sometimes leaving a temporary tube), which relieves the emergency; however, because sigmoid volvulus commonly recurs, surgery is often recommended afterwards (or during the same admission) to prevent it happening again. For other types (such as caecal volvulus), or where the bowel is already damaged or the twist cannot be relieved non-surgically, surgery is needed — to untwist and often remove the affected segment of bowel and prevent recurrence. In babies with a midgut volvulus, urgent surgery is required. Supportive care (fluids, resting the bowel) is given alongside. The overriding message is that a volvulus is a medical emergency — a twisted bowel that can rapidly cut off its own blood supply — so severe tummy pain with a swollen tummy and vomiting needs urgent assessment, and prompt treatment can save the bowel.