What is Volvulus? Untwisting the Symptoms, Causes, Treatments, and Prevention!

The term volvulus stems from theLatin verb "volvere", which means"to turn about" or"to roll". The medical professionals use this term to describe a medical condition where the intestine turns on itself and itsmesentery — the organ in the abdomen that attaches the intestines to the abdominal wall.

When this happens, it can lead tobowel obstruction or even cut off the blood supply to the affected area, causing tears in the intestinal wall. This is a medical emergency that requires immediate treatment.

Why Does Volvulus Happen? 

The cause of volvulus is typically different for infants and adults. In infants, volvulus affects the small intestine. But in adults, volvulus usually involves the colon and is called a ‘sigmoid volvulus’.

In infants and children, volvulus of the small intestine is usually the result ofmalrotation or the wrong positioning of the small intestine within the abdomen. This can cause the intestine to twist or become blocked. 

Malrotation is the most common cause of volvulus in infants, but it’s very rare among adults.

In adults, a sigmoid volvulus can be theresult of:

• An enlarged colon

• Abdominal adhesions that develop after surgery, injury, or infection

• Diseases of the large intestine, such asHirschsprung’s disease

• A colon that is not attached to the abdominal wall

• A narrow connection at the base of the colon

• Chronicconstipation

• Pregnancy 

How Serious is a Volvulus? 

Volvulus can be a very serious condition. When the intestine twists in on itself, it can cause a bowel obstruction, cutting off the blood supply to the area. This can result in necrosis or tissue death of the obstructed area, which is a life-threatening situation. 

Twisting of the intestine can also cause the intestinal wall to tear, which then leaks intestinal content into the surrounding areas, potentially causing severe infection (peritonitis). Ultimately, it can cause sepsis – an infection throughout the physical system. Sepsis is deadly if it is not treated immediately. 

Can a Volvulus Resolve Itself?

No, these cases usually require urgent medical intervention and won't resolve by themselves. 

Sigmoid volvulus is the most common type of volvulus. It happens when the sigmoid colon, or the part closest to the rectum, twists around itself. When the sigmoid colon twists, the mesentery twists with it. This often causes restricted blood flow to the affected part of the colon.

While the victim experiences severe pain, bloating, and constipation, the colon itself is getting damaged due to restricted blood flow. This damage can lead to tissue death, severe infection, or tears in the bowel, which can be life-threatening

How is Gastric Volvulus Treated? 

The treatment of volvulus isan immediate operation that reduces and untwists the volvulus. For patients at high risk for surgery, surgeons opt for endoscopic reduction – a procedure where an endoscope containing a camera is inserted into the body. 

Once inside, the surgeon tries to untwist the bowel. If tissue death has already occurred or the bowel has been perforated, the surgeon will remove the affected tissues surgically.

If so much of the intestine was removed that the two ends can't meet, the surgeon will create openings in the abdominal wall and attach the ends to these openings, called stomas. In the future, the patient's intestinal contents will pass through the stoma into an ostomy pouch. This may be permanent or temporary.

The other treatment for volvulus is sigmoidoscopy. The procedure is an examination of the rectum and the lower part of the colon, using a flexible tube with a camera. The insertion of the tube itself sometimes facilitates the untwisting of the colon. 

What Happens If a Volvulus is Left Untreated?

If a volvulus is not diagnosed correctly and treated immediately, the consequences can be dire. An untreated volvulus can lead to restricted blood flow, resulting in ischemia (lack of oxygen to tissue) and necrosis (death of bowel tissue). 

Dead or damaged bowel tissue can tear, causing intestinal contents to leak into the abdominal cavity. This condition, known as peritonitis, is extremely dangerous.

A bowel that has ruptured can cause the patient to go into septic shock, which can cause widespread organ failure and death.

What Foods to Eat for Volvulus?

If you have volvulus, you need surgery. And so, what you eat can't prevent an operation or cure volvulus. However, if you are constipated and run the risk of developing the condition, you can consider a diet to prevent bowel obstruction.

Queensland Health, Australia, provides aModified Diet for the Prevention of Bowel Obstruction. This diet focuses on soluble fiber and limits the intake of insoluble fiber. 

Insoluble fiber is not digested by the body and reaches the colon intact, which can cause a build-up of intestinal matter, leading to a bowel obstruction. Examples of insoluble fiber that should be avoided include the skins of fruits and seeds, vegetable skins and seeds, whole grains like whole-wheat, brown rice, and quinoa, nuts, and seeds. 

Tough fibrous fruits and vegetables, such as mango and celery, should be chopped finely. Dried fruit and nuts should also be avoided.

Foods that are fine for a modified diet to avoid bowel obstruction include:

Fruits and Vegetables with Low or Moderate Fiber:

• Potato (with the skin removed)

• Pumpkin

• Zucchini 

• Cauliflower

• Mushrooms

• Melons

• Canned fruit (not pineapple)

• Fruit juice (not pulp)

• Well-cooked fruit without skins or pips 

Protein

• Fish

• Chicken

• Tofu

• Eggs

Dairy

• All varieties of milk

• Yogurt

• Plain cheese

Grains

• White bread

• Sourdough bread

• White rice

• White pasta

• Instant oats

• Low-fiber crackers

• beans and lentils

Further Suggestions

• Eat slowly and chew all food well.

• Chop food finely and cook it well.

• Don't eat food that is tough or stringy. 

• Eat more often but smaller meals.

• When preparing food, remove skins, pits, and seeds.

• Cooked veggies may be better tolerated

Should I Not Take Fiber for Volvulus?

You can eat fiber, but focus on soluble fiber. Don't eat insoluble fiber – doing that can worsen your condition.

Foods to Avoid in Volvulus?

Foods to avoid in volvulus include:

• Fibrous fruits and vegetables

• Seeds

• Nuts

• Whole grains like brown rice, whole wheat, and quinoa

• Juice with pulp

• Raw vegetables

Conclusion

Volvulus is a serious medical condition that requires intervention. It can cause extremely painful stomach cramps and bloating. If it is not treated, the twisting of the colon and mesentery can become life-threatening. If you ever experience severe stomach cramps, get in touch with your physician immediately. 

Early diagnosis and treatment are critical for a full recovery and to prevent long-term complications.