Colon volvulus: Possible complications

The article was expertly consulted by MSc Duong Xuan Loc - Gastroenterologist - General Surgery Department - Vinmec Da Nang International General Hospital.

Colon volvulus is a common, obstructive, ischemic disease that can lead to necrosis and perforation of the colon. The twist can be up to about 180 - 540 degrees. Colon volvulus causes local intestinal distention, as peristalsis pushes stool and gas to the volvulus, causing increased pressure.

1.1 Sigmoid volvulus The most common type of colonic volvulus (accounting for 8% of patients with intestinal obstruction), occurs at any age, but is common in patients over 50 years of age and in children. out more in men.
Up to now, the cause of sigmoid volvulus has not been confirmed specifically, but some experts have suggested the causative factors such as:
The sigmoid colon is longer than usual. The two legs of the sigmoid colon are close together due to thickening. People with frequent constipation. People with congenital megacolon. Result from some other disease or infection. The root of the sigmoid mesentery is short. Torsion of the sigmoid colon twists counterclockwise. Twisting one and a half turns can cause vascular obstruction and necrosis leading to intestinal perforation at the base or apex of the loop.
1.2 Cecal torsion Caecal torsion is a fairly common condition (1-3 percent of patients with intestinal obstruction), usually occurring between the ages of 20-40.
The main cause of cecal torsion is abnormal fixation of the colon to the cecum, to the abdominal wall. Disease-causing agents such as:
Pregnant women, pelvic tumors Thick and sticky Habit of overeating. There are 2 types of cecal volvulus:
Collapse of the colon around the ascending axis, in 2⁄3 of the patients in this case leading to necrosis. Angle cecal flexion: The cecum is folded upward along the transverse axis due to the adhesions.

The first symptom is severe abdominal pain in the twisted area, then spreading throughout the abdomen. Abdominal distention: If the abdominal distention on the left side is a sign of sigmoid volvulus, on the right side it will be a cecal torsion. Enlarged abdomen. Hiccups and vomiting. In addition, the patient also had bowel obstruction. If not treated promptly, it will lead to hypotension, sepsis, difficulty breathing, ... In the case of patients with necrotic colonic volvulus, it will cause fever, pain when pressing the abdomen, in other cases if If the colon is perforated, the prominent symptom is generalized peritonitis, with symptoms such as shock, infection, intoxication,...

Most cases with suspected colon torsion when coming to the hospital for examination will be X-ray or computed tomography of the colon to diagnose the disease.
3.1 If there is no sign of necrosis Treat by devolving through Barium enema or colonoscopy. Then surgery is needed to attach the colon and cecum to the abdominal wall.
3.2 If there are signs of necrosis, urgent surgery is needed. The mortality rate is quite high due to delayed diagnosis or improper treatment. In the elderly at risk of surgical complications, surgery is only indicated when the treatment of torsion has failed or has been necrotic.