Volvulus

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Classification according to ICD-10
K56.2 Volvulus
ICD-10 online (WHO version 2019)
Twist and gangrene of the sigmoid colon
Volvulus mesenterialis in a dog, triggered by a rotation of the complete mesentery around the mesenteric root . The discolored, dilated and atonic loops of the small intestine , the congestion of the mesenteric vessels and the multifocal hemorrhage should be noted

In medicine, a volvulus , generally also called intestinal twisting or twisting , is a rotation of a section of the digestive tract around its mesenteric axis. The rotation restricts the blood supply to the affected section of the digestive tract, which runs in the mesentery. It can lead to intestinal obstruction or even destruction of the affected section ( intestinal gangrene ). A suspected acute volvulus in childhood is therefore a pediatric surgical emergency.

frequency

It occurs most often on the caecum and sigmoid . In the small intestine area, the volvulus usually occurs as a result of malrotation .

In childhood, the incidence is the same in all age groups , but complications in the sense of intestinal destruction ( gangrene ) are more common in newborns under 30 days .

Symptoms

Prenatal volvulus

The volvulus can appear prenatal. Such a situation can result in intestinal atresia due to the loss of intestinal parts .

Acute volvulus

Chronic recurrent volvulus

diagnosis

Sigmavolvulus on the X-ray with the so-called coffee bean mark

The diagnosis is made on the basis of the clinic and x-rays of the abdomen (possibly with contrast agent), and recently also by means of ultrasound. The diagnosis can be difficult, especially in newborns, as the clinic only shows a swelling of the abdomen and the X-ray image can be unspecific.

In the case of the volvulus of the sigmoid colon , a so-called coffee bean sign is often found due to a massive overinflation of this part of the intestine, in which an ascending loop is placed close to a descending one, so that the contour of an oversized coffee bean results. If the perforation has already taken place, there is so-called "free air" in the X-ray image .

The diagnosis of chronic recurrent volvulus can also prove to be very difficult as it can only be made during an acute episode.

The most important differential diagnosis to acute volvulus is intussusception .

treatment

Acute volvulus

The treatment consists in restoring the correct position of the corresponding section of the intestine as quickly as possible. If a volvulus is suspected (except sigmoid - see below ), an operation is carried out quickly, since this section of the digestive tract can quickly disappear if there is an insufficient supply of blood. The turned back intestine or stomach at the gastric volvulus is possibly still fixed. If parts are already damaged to such an extent that the function cannot be re-established, these parts are removed. If necessary, an enterostomy must be created temporarily .

Sigmoid special case

In the case of a volvulus of the sigmoid without peritonitis , derotation can be attempted with a probe carefully inserted through the anus and an enema. If this is not successful, an operation is also carried out.

Chronic volvulus

If chronic volvulus is proven, an attempt can be made to fold the affected section of the digestive tract like an accordion by means of surgery and to fix the folds with sutures (small intestine plication according to Noble) or to fix the folded loops with sutures (e.g. using the Childs method) on the mesentery.

forecast

Particularly in the presence of an acute small intestine volvulus, large parts of the intestine can die, which can lead to short bowel syndrome with possibly lifelong consequences.

literature

See also

Web links

Commons : Volvulus  - collection of images, videos and audio files
Wiktionary: Volvulus  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Ernst Kern : Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , p. 180.