Volvulus, (Twisted Intestines) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

by Kenneth Kee

Overview

Volvulus is the medical disorder for a complete twisting of the bowels around the mesentery attachment site supporting the bowels.
It is an infrequent disorder that can affect the stomach, small intestine or parts of the large intestine and is mainly observed in infants or children even though certain types may happen in adults.
It can also result in the obstruction of the blood supply to the whole intestine itself, which can lead to tissue death within the bowel
The volvulus is when a loop of intestine twists around itself and the mesentery supporting it, leading to a bowel obstruction.
Complete obstruction stops food, chyme and waste from traveling further and induces it to back up in the intestines.
The twisting also obstructs the bowel wall so that blood vessels may become blocked.
This may decrease the blood flow through it and reduce the intestinal tissue of oxygen.
Ultimately this will result in ischemia, injury linked with decreased blood flow, or persists further to the point that the tissue of the intestinal wall dies and can even become gangrenous.
Types of Volvulus
Neonatal Volvulus is a result of malrotation during fetal development
Sigmoid Volvulus accounts for 8% of all intestinal obstructions, frequent in elderly persons and constipated patients.
Cecal Volvulus is connected to the abdominal wall along with the ascending colon due to an anatomic anomaly.
Gastric Volvulus is a twisting of the stomach which may involve the cardia (first part of the stomach) or the complete stomach.
In adults the most often involved segment of the intestines is the sigmoid colon with the cecum being second most involved.
A volvulus tends more likely to happen with an anatomic anomaly even in the absence of any other disease.
A volvulus may start with certain diseases:
1. Hirschsprung disease
2. An enlarged colon (Megacolon)
3. Intestinal pseudo-obstruction
4. Intussusception
Volvulus is most often caused by a birth defect called malrotation
Volvulus produces symptoms by:
1. The extent of bowel obstruction manifested as abdominal distension and bilious vomiting
2. Ischemia (reduced blood flow) to the involved section of the intestinal wall
Sigmoid volvulus is the most frequent form of volvulus.
Patients have abdominal pain, distension, and complete constipation
Volvulus happens most often in middle-aged and elderly men.
Infants affected by volvulus have an abrupt start of symptoms the same as those of bowel obstruction.
Diagnosis:
1. Blood tests to assess the electrolytes may show abnormalities.
2. Stool guaiac reveals blood in the stool
3. Barium enema often reveals an abnormal position of the bowel, indicating malrotation.
4. CT scan may show evidence of intestinal obstruction.
5. An upper GI X-ray with small bowel follow-through reveals a malrotated bowel or midgut volvulus.
Non-surgical treatment
This may be suitable for older patients with intestinal malrotation who are asymptomatic but they should be cautioned that volvulus can happen at any time.
Examination and GI decompression with a nasogastric or orogastric tube should be started.
The presence of any intestinal obstruction requires instant surgery
The patient is resuscitated with intravenous isotonic crystalloid solution to correct fluid deficits and hypo-volemia (low blood volume).
Sigmoidoscopic de-torsion is effective in more than 90% of patients with sigmoid volvulus, but colonoscopic de-torsion is effective in only 10-15% of patients with cecal volvulus.
1. Ladd's procedure is the treatment of preference in most patients
It can be done with open surgery or as a laparoscopic procedure.
2. Sigmoid Colectomy and Hartmann Procedure for Sigmoid Volvulus
3. Right Hemicolectomy for Cecal Volvulus
TABLE OF CONTENT
Introduction
Chapter 1 Volvulus
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Intestinal Motility Disorders
Chapter 8 Intussusception
Epilogue

Product Details

BN ID:	2940154495162
Publisher:	Kenneth Kee
Publication date:	08/05/2017
Sold by:	Smashwords
Format:	eBook
File size:	122 KB

About the Author

Medical doctor since 1972. Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009. Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993. Dr Kenneth Kee is still working as a family doctor at the age of 65. However he has reduced his consultation hours to 3 hours in the morning and 2 hours in the afternoon. He first started writing free blogs on medical conditions seen in the clinic in 2007 on http://kennethkee.blogspot.com. His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog afamilydoctorstale.blogspot.com. This autobiolographical account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com. From which many free articles from the blog was taken and put together into 550 amazon kindle books and some into Smashwords.com eBooks. He apologized for typos and spelling mistakes in his earlier books. He will endeavor to improve the writing in futures. Some people have complained that the simple guides are too simple. For their information they are made simple in order to educate the patients. The later books go into more details of medical conditions. The first chapter of all my ebooks is always taken from my blog A Simple Guide to Medical Conditions which was started in 2007 as a simple educational help to my patients on my first blog http://kennethkee.blogspot.com. The medical condition was described simply and direct to the point. Because the simple guide as taken from the blog was described as too simple, I have increased the other chapters to include more detailed description of the illness, symptoms, diagnosis and treatment. As a result there are the complaints by some readers of constant repetitions of the same contents but in detail and fairly up to date. He has published 550 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter. The purpose of these simple guides is to educate patient on health conditions and not meant as textbooks. He does not do any night duty since 2000 ever since Dr Tan had his second stroke. His clinic is now relocated to the Bouna Vista Community Centre. The 2 units of his original clinic are being demolished to make way for a new Shopping Mall. He is now doing some blogging and internet surfing (bulletin boards since the 1980's) starting with the Apple computer and going to PC. All the PC is upgraded by himself from XT to the present Pentium duo core. The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive. He is also into DIY changing his own toilet cistern and other electric appliance. His hunger for knowledge has not abated and he is a lifelong learner. The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned. This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale. Dr Kee is the author of: "A Family Doctor's Tale" "Life Lessons Learned From The Study And Practice Of Medicine" "Case Notes From A Family Doctor"