The bowels are comprised of the small and large intestine in the human body. The small intestine is divided into three main parts: the jejunum, the duodenum, and the ileum. The large intestine consists of three main parts: the cecum, the rectum, and the colon.
The most worrisome issue with a twisted bowel is that necrosis or cell death will occur if the abnormality is not fixed in time due to the obstruction of blood flow to the area.
In the western world, the incidence of small bowel volvulus occurs in about 1.7 to 6.2 percent of adults. It may result from a primary cause occurring in the abdominal cavity or, more commonly, a secondary cause such as an anatomic malformation, adhesions, tumors, or diverticula.
Types of Volvulus
Volvulus can manifest in various sections of the large intestine, resulting in different types of twisted bowel. Some of the common types include:
1. Volvulus of the Cecum
In this case, the cecum, which is the pouch-like structure at the start of the large intestine, becomes twisted. This is known as Cecal Volvulus and it can lead to blockages and compromised blood supply, potentially causing severe complications.
2. Volvulus of the Transverse Colon
The transverse colon, a central part of the large intestine, can also become twisted, causing similar symptoms and complications.
3. Sigmoid Colon Volvulus
The sigmoid colon, located towards the end of the large intestine, is particularly susceptible to twisting due to its anatomy. This type of volvulus is one of the most common and can lead to symptoms ranging from discomfort to serious complications.
What Causes a Twisted Bowel?
Volvulus can develop in any portion of the large bowel, with the sigmoid colon being the most common and being due to mesenteric anatomy—the soft tissue that attaches the intestines to the wall of the abdomen. Having a long mesentery with a narrow base of fixation may predispose a person to develop a twisted bowel.
The answer to what causes a twisted bowel is not always clear. However, there are particular clues and associations that the medical community has discovered that may contribute to the condition.The following are such causes:
- Intense gut mobility: The use of laxatives, adhering to a diet high in fiber, and disorders of the intestines can lead to the development of a twisted bowel. Having the intestines work extra hard can lead to them wind up.
- Overeating: Eating excessive amounts of food can overwhelm the intestines, making them sag, loop, or distend downward, causing the intestines to twist.
- Intestinal malrotation: Due to an existing problem of the bowel that hasn’t shaped properly or doesn’t align accurately with the abdomen. These conditions are often recognized early in life and put those affected at risk.
- Abdominal adhesions: Adhesions occur due to improperly placed scar tissue between the sections of the bowel. These bands can pull the intestine, introducing kinks that eventually lead to a twisted bowel.
- Diverticulosis: Protrusions of the intestinal lining that appear as small sacs. Having an overabundance of these protrusions of the intestinal lining might cause the intestine to twist in on itself, leading to significant obstruction. Diverticula might be congenital (occurring at birth) or develop over time as you get older.
- Intestinal Detorsion: Rarely, a condition known as intestinal detorsion can occur. This involves the spontaneous resolution of a twisted bowel due to the bowel’s own natural contractions and movements. While uncommon, this self-correction can alleviate the twisting and restore normal bowel function.
- Other causes: Although rare, other causes include certain cancers, pregnancy, old age, changes in dietary habits, or problems with post-surgical recovery.
What Are the Symptoms of Twisted Bowels?
Twisted bowel symptoms can often present differently depending on the underlying cause, with varying severity levels. Mild conditions of volvulus may not present with any serious complications; however, serious cases may lead the bowel to become starved of oxygen and nutrients provided by having adequate blood supply. Serious causes of twisted bowel result in intestinal strangulation, and if left untreated, can lead to entire segments of the intestinal tract to die off.
Commonly reported symptoms of a twisted bowel include:
- Nausea/vomiting: Severity that serious cases of twisted bowel can inflict on a person can lead to feelings of nausea and vomiting.
- Dehydration: Having a twisted bowel will eventually lead to passing watery diarrhea. If fluids aren’t replaced in a timely fashion, dehydration will soon set in.
- Abdominal distension: When a patient experiences prolonged cases of twisted bowel, it may lead to inflammation or distension. Abdominal distention can also be caused by constipation or a problem with passing gas. Those affected will often also experience tenderness of the abdominal region.
- Pain: A common symptom and often represents a restriction of blood flow to a bowel segment. Pain may be experienced differently from patient to patient with cramps also being part of the presentation. Bowel pain due to volvulus may cause sudden spasms and contraction of muscles.
- Fever: Often a consequence of serious volvulus and inflammation.
- Malnutrition: Twisting of the bowel will not allow food to pass through the intestines in an efficient manner. This is will for vitamins and nutrients found in food to be inadequately absorbed.
- Lack of appetite: Those with volvulus tend to lose their desire to eat due to their abdominal symptoms.
What Happens If Volvulus Is Left Untreated?
Timely diagnosis and treatment are essential. Understanding the potential consequences of leaving volvulus untreated is equally crucial.
The Dangers of Untreated Volvulus include the following
1. Necrosis and Tissue Death
One of the most concerning outcomes of untreated volvulus is the development of necrosis, which refers to the death of tissue due to inadequate blood supply. The twist or loop in the intestines can exert pressure on blood vessels, restricting blood flow to affected segments. Without a steady supply of oxygen and nutrients carried by the blood, the tissues become deprived, leading to necrosis. If left unchecked, necrosis can progress rapidly and compromise the integrity of the affected intestinal segments.
2. Intestinal Perforation
As the volvulus continues to exert pressure and restrict blood flow, it can weaken the walls of the intestines. This weakening, coupled with the deteriorating condition of the tissue due to necrosis, increases the risk of intestinal perforation. Intestinal perforation involves a rupture or hole in the intestinal wall, allowing the contents of the intestines to spill into the abdominal cavity. This can trigger a severe inflammatory response known as peritonitis, leading to excruciating pain, infection, and potential systemic complications.
3. Sepsis and Systemic Infection
If untreated volvulus leads to intestinal perforation and subsequent peritonitis, the risk of sepsis—a life-threatening condition arising from a severe infection—increases significantly. Sepsis occurs when the body’s immune response to infection becomes uncontrolled, leading to widespread inflammation and damage to organs. Left untreated, sepsis can lead to multiple organ failure and even death.
4. Bowel Gangrene
The combination of necrosis, compromised blood supply, and potential perforation can result in a condition known as bowel gangrene. Bowel gangrene occurs when a portion of the intestines undergoes irreversible tissue death due to untreated volvulus. This condition demands immediate medical attention, as it poses a serious risk to the patient’s life. Emergency surgery to remove the affected segment of the intestine may be required to prevent further complications.
5. Progression of Symptoms
As volvulus remains untreated, the symptoms associated with the condition tend to worsen. Individuals may experience escalating abdominal pain, bloating, nausea, vomiting, and constipation. The discomfort can become unbearable, significantly impacting the individual’s quality of life.
Diagnosing And Treating Twisted Bowels
Having a twisted bowel will often present with the symptoms mentioned. While not all of these signs may be seen in your case, the symptoms you present to the doctor will point to some abnormality occurring within your abdominal cavity, prompting further investigation.
The first order of business will often include ruling out any secondary causes such as a previous abdominal surgery causing adhesions or the use of any substances that affect bowel physiology. Once a cause is suspected, imaging tests will be implemented to get a better idea of how the bowel looks. Possible testing includes:
- Stool analysis
- Barium enema
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
In mild, non-bowel-strangulation cases of twisted bowel, a person may be given conservative management, as it is possible for the bowel to move back into its normal position over time. This may include diet modification, colon cleansing/irrigation, and regular exercise.
An emergency sigmoidoscopy or colonoscopy for decompression of the volvulus may also be utilized if the case permits it. Occasionally, pressure from introduced air into the bowels can reduce the twisted bowel. This procedure is successful in more than 90 percent of patients with sigmoid volvulus but only 10 to 15 percent successful in those with fecal volvulus.
Serious cases of volvulus will require surgery and are considered the best option for treating and preventing the possibility of bowel strangulation. Sugary often involves straightening the bowel so that it will return to its normal state. Cases, where tissue death has already occurred, will result in a complete or partial bowel resection.
Are there any Non-Surgical Options to Treat volvulus?
Dealing with a twisted bowel, or volvulus, can be daunting, but there are non-surgical options to consider alongside surgical interventions. These alternatives are often viable for less severe cases where the twist can be managed without invasive procedures.
1. Endoscopic Decompression: Endoscopic decompression involves using a flexible tube with a camera to access the intestines. This approach is effective for sigmoid volvulus, untwisting the colon by introducing air or water. However, success depends on the twist’s severity and blood supply status.
2. Colonoscopy for Detorsion: In certain cases, a colonoscopy can be employed to untwist the volvulus. This method navigates the intestines with a flexible tube to relieve the twist. Its success relies on factors like the type of volvulus and the patient’s condition.
3. Observation and Monitoring: Mild cases of volvulus may be closely monitored without immediate intervention. Watching for symptom changes ensures timely action if the twist worsens.
How Do You Prevent a Twisted Bowel (Volvulus)?
Guarding against the occurrence of a twisted bowel, known as volvulus, involves understanding contributing factors and adopting preventative measures. Here are essential steps to consider:
1. Healthy Dietary Habits: Maintaining a balanced diet rich in fiber promotes regular bowel movements and minimizes the risk of constipation, a factor linked to volvulus.
2. Portion Control: Avoid overeating, as excessive food consumption can strain the intestines and lead to twisting.
3. Hydration: Staying adequately hydrated ensures soft stool consistency and facilitates smooth bowel movements.
4. Addressing Underlying Conditions: Conditions like diverticulosis predispose individuals to volvulus and require proper management under medical guidance.
5. Exercise: Engaging in regular physical activity supports healthy gut function and helps prevent excessive gut mobility.
6. Mindful Eating: Chewing food thoroughly and eating slowly aids digestion, reducing the likelihood of intestinal complications.
Prognosis Of Volvulus
Waiting too long to diagnose and treat various types of volvulus is associated with poor outcomes or even death. It is estimated that 30 to 40 percent of delayed fecal volvulus conditions result in death.
Although volvulus can be effectively treated through endoscopic decompression and surgical resection, research suggests a mortality rate ranging from 12 to 15 percent. Recurrence is experienced by as many as 50 percent of patients who undergo endoscopic decompression alone.
Endoscopic decompression as a standalone treatment for sigmoid volvulus has been observed to have a recurrence rate of 40-50%, with a mortality rate of 25-30% following surgical intervention for recurrent volvulus.