Volvulus is a familiar wording for many since childhood. After all, it was they who frightened the children’s parents so that they would not eat a lot of junk food. However, what exactly constitutes such a torsion is not always clear. What is the essence of the pathology, why is it dangerous and how to deal with it, aif.ru told Doctor of the highest category, Doctor of Medical Sciences, Head of the Department of Abdominal Surgery and Oncology, NCC No. acad. B. V. Petrovsky”, surgeon-oncologist, coloproctologist Arkady Bedzhanyan.
A torsion of the intestine is understood as a situation when the loop of the intestine twists around itself and its mesentery (dense fold of the abdominal membrane). Against this background, intestinal obstruction is formed. Volvulus accounts for 2% of all cases of obstruction. Most often, such a problem is encountered in the area of the sigmoid colon (the penultimate section of the colon) – this problem is noted here in 75% of cases. Moreover, men and people of age are usually at risk.
What is the danger of the condition?
Intestinal volvulus is dangerous not only because intestinal obstruction is formed against the background of overlapping of the intestinal lumen due to twisting, but also because the blood supply stops in this area. Because of this, intestinal ischemia develops and its further necrosis (death). Necrosis may be accompanied by septic shock and has a rather unfavorable prognosis.
There are a number of factors that increase the risk of developing such a pathology. These include:
- anomaly in the development of the intestine – malrotation. With it, the intestines cannot take their place in the abdominal cavity, as it should be normal. The anomaly is laid still in utero;
- lengthening of the colon;
- Hirschsprung’s disease (absence of nerve cells in the muscles and submucosal layer, there is no contraction in this part of the intestine and stagnation forms);
- adhesions in the abdominal cavity, which were formed against the background of previous operations.
Volvulus often develops in people with Parkinson’s disease, multiple sclerosis. In addition, some caution should be exercised by those who use a diet high in fiber, suffer from chronic constipation, when it is necessary to use laxatives for a long time to solve the problem.
There is a certain difference in the localization of the process, depending on the age of the person. So, in adults, most often the problem occurs in the region of the sigmoid and caecum. In children, this pathology is more often diagnosed in the small intestine.
Why does pathology develop?
There are a number of reasons that can serve as a trigger for the development of the disease. Among them:
- injuries in the abdomen;
- a sharp turn of the body;
- being in a forced unusual position;
- weight lifting;
- episodes of overeating, especially those that occur after prolonged fasting;
- the presence of hernias of the anterior abdominal wall;
If there were such situations with a person, and he felt unpleasant symptoms after, you should not delay and try to cope with the problem with painkillers. You should urgently consult a doctor.
What symptoms should alert?
Signs of intestinal damage can be due to two mechanisms – one relating to impaired patency, the second refers to impaired blood supply. Depending on how the intestine is wrapped, the manifestations may vary.
So, you can feel:
- pain and cramps in the abdomen;
- nausea and even vomiting.
If the volvulus has occurred in the sigmoid colon, symptoms such as spasms, bloody stools, constipation, nausea and vomiting, and signs of shock develop. Severe pain is noted when twisting. Damage to the walls of the intestine due to the death of parts of the organ is at a progressive pace. Perforation and peritonitis may develop.
How are they treated?
If only there is a suspicion of volvulus, the person should be immediately hospitalized. After all, the treatment takes place in the intensive care unit. The treatment regimen provides for the correction of electrolyte disturbances (they become the result of dehydration), the use of antibiotics.
Treatment begins with sigmoidoscopy (a diagnostic method in which the intestinal mucosa is examined). During such a diagnostic event, you can not only identify the problem, but in some cases even “straighten” the gut. However, the procedure is not performed if there is a suspicion of intestinal gangrene.
The optimal solution for volvulus is considered a surgical operation, in which the affected area of \u200b\u200bthe intestine is removed. The operation is recommended to be performed after endoscopic measures and correction of blood parameters.
During treatment, it is necessary to resort to the installation of a temporary enterostomy – a special opening for the removal of feces.
It is better to try to prevent the disease, as it is fraught with serious consequences and negative prognosis.
First of all, people at risk should take care of prevention. Accordingly, it is necessary to establish nutrition so that fiber does not predominate in it, and the composition is such as to eliminate constipation in a natural way without taking laxatives and enemas. Special attention should be paid to taking antipsychotics – discuss them with your doctor and look for replacements if the risks of bloat are high. In addition, it is important to adjust the lifestyle in favor of where there will be more movement, since physical inactivity negatively affects the work of the intestines. Overeating, especially at night, and heavy physical labor should be avoided.