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What is Volvulus
The term “volvulus” derives from the Latin volvere, or “to twist.” A volvulus is a condition that occurs when a portion of a bowel twist around its mesenteric or self, causing an obstruction, blocking and impairing normal flow of food, liquid and gases. It commonly affects the large intestines, mostly the sigmoid resulting in intestinal or bowel obstruction but can also affect other part of the digestive tract such bas the small intestines, transverse colon, stomach and he caecum, but these are rare cases. A close loop obstruction forms within the affected part of the bowel. The twisting also causes compromise blood supply to the affected part leading ischemia, necrosis and possibly gangrene and perforation of the bowel and also symptoms such as severe abdominal pain, bloating, nausea, and vomiting
Twisting of the bowel
Incidence of Volvulus
Worldwide, colonic volvulus is the third leading cause of large bowel obstruction. Advance aging and neurological disorders (e.g. Parkinson's disease or vascular dementia), put people at greater risk also individuals on anti-psychotics, patients with reduced mobility, and male gender are also at risk
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Causes & Risk factors of Volvulus
The exact cause of volvulus is unknown but several factors can contribute to the development of volvulus. The following are understood to contribute to its development
- Abdominal adhesion
- Chronic constipation
- A high-fiber diet
- Intestinal malrotation
- A long mesentery
- Hirschsprung disease
- Past abdominal surgery
- Pregnancy
Signs & Symptoms of Volvulus
- Abdominal distention
- Abdominal tenderness
- Bloating
- Blood in stools
- Constipation
- Diarrhea
- Nausea
- Vomiting, which is rare
Diagnostic Investigations of Volvulus
- Physical examination
- Blood tests
- Abdominopelvic CT scan with intravenous contrast
- Abdominal X-rays
- Abdominal ultrasound
- Contrast Enema
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Treatment of Volvulus
The goal of treating is fixing the twisted bowel and preventing future episodes of the condition. Treatment option depends on non-surgical and surgical management.
Non-surgical treatment, patients need to be fluid resuscitated before surgery. Monitoring of vital signs, administering of broad spectrum antibiotics, adequate analgesia, fluid intake and urine output monitoring is important preoperatively.
Sigmoidoscopy with decompression procedure is used to reduce (the process of untwisting the intestines) the volvulus. Detorsion can be done using a colonoscope or during a sigmoidoscopy procedure.
A soft flatus tube or red rubber tube can be inserted insitu for detorsion and decompression
Surgical therapy is recommended for patients with a sigmoid volvulus with evidence of bowel ischaemia, necrosis or perforation
Surgical intervention for a sigmoid volvulus includes removing part of the bowel and then either reconnecting it or creating a colostomy. To prevent further recurrence, patients with recurrent volvulus may undergo an elective surgery, either as a sigmoid colectomy with primary anastomosis or end colostomy
Nursing Care of Volvulus
- Assess and monitor the individual's pain
- Monitor and document patient vital signs, urine output, and laboratory results
- Administer prescribed analgesics as ordered
- Implement non-pharmacological pain management strategies, such as heat therapy, positioning, relaxation techniques, or distraction.
- Collaborate with the healthcare team to develop an individualized pain management plan
- Monitor patient fluid intake and output
- Monitor patient for dehydration and or fluid overload.
- Collaborate with the healthcare team to establish an appropriate intravenous (IV) fluid therapy plan
- Administer prescribed medications
- assess and maintain fluid and electrolyte balance.
- Ensure patient has obtained consent form
- Monitor the patient nutritional status
- Maintain patient NPO status
- Assist and prepare patient for surgery
- Explain the importance of maintaining regular bowel movements, adequate hydration, and preventive measures to avoid recurrence.
Complications of Volvulus
- Sepsis
- Fecal fistula
- Secondary peritonitis
- Anastomotic leak
- Short bowel syndrome
- Recurrence
- Wound infection
- Complications of colostomy and/or ileostomy
Differential Diagnosis
- Abdominal hernia
- Colonic polyps
- Diverticulitis
- chronic Megacolon
- toxic Megacolon
- Rectal cancer
- Intussusception
- Intestinal perforation
- Intestinal pseudo-obstruction
