Symptoms of intestinal volvulus vary depending on the condition!

Intestinal volvulus is a very fast-developing intestinal obstruction disease, which can be divided into small intestinal volvulus, in which the patient develops suddenly and has persistent severe abdominal pain; sigmoid colon volvulus, in which the patient has persistent abdominal distension and pain that gradually bulges; cecal volvulus is relatively rare.

1. Small intestinal torsion is the most common, often occurring in young and middle-aged male manual laborers. There is often a history of overeating and strenuous activity before the onset of the disease. The onset is sudden, with persistent severe abdominal pain and paroxysmal aggravation. There is pain around the umbilicus first, which can radiate to the waist and back. This is only due to the pulling of the root of the mesentery. Vomiting is frequent, the abdomen is obviously distended, there is tenderness when waking up in the morning, but there is no muscle tension, the bowel sounds are weakened, and the sound of gas passing through water can be heard. Abdominal X-rays may show different results depending on the location of the small intestine twist. In the case of complete small intestinal volvulus, only the stomach and duodenum may be inflated and dilated, but the small intestine may also be generally inflated with multiple fluid levels. When part of the small intestine twists, a huge bloated, enlarged intestinal loop with fluid and air surfaces may appear in a certain part of the abdomen. Due to intestinal and intra-abdominal exudate and bleeding, coupled with the translocation of pathogenic bacteria in the intestine, the patient quickly develops hypovolemic shock and septic shock. Generally, only the diagnosis of strangulated intestinal obstruction can be made before surgery, and the condition of intestinal volvulus can be determined during surgery.

2. Sigmoid colon volvulus is more common in elderly men, who often have a history of lengthy sigmoid colon or constipation. The patient has persistent abdominal distension and pain, which gradually bulges, and a feeling of heaviness in the lower abdomen, but no flatulence or bowel movement. There is obvious distension in the left abdomen, with intestinal pattern visible. Percussion produces a tympanic sound, but tenderness and muscle tension are not obvious. Plain X-rays show huge double-lumen air-filled intestinal loops with fluid levels. This type of sigmoid colon torsion is more common and can recur. Some other patients present with acute attacks, severe abdominal pain, vomiting, tenderness on palpation, and muscle tension, indicating severe torsion, obvious intestinal congestion and ischemia, and intestinal necrosis may occur if not treated in time.

3. Cecal volvulus is rare and mostly occurs in patients with a movable cecum. It can be divided into acute and subacute types. Acute volvulus of the cecum is uncommon and has an acute onset with severe pain and vomiting. There is a palpable mass in the right lower abdomen with tenderness, which may cause cecal necrosis and perforation. The subacute type has a slower onset. The patient complains of colic in the right lower abdomen. The abdomen quickly bulges and becomes asymmetrical. An elastic mass can be felt in the upper abdomen. Plain X-rays show huge gas-filled intestinal loops with multiple gas-filled fluid levels.

If there is sigmoid colon or cecal torsion but no symptoms of peritonitis, low-pressure barium enema can be considered to confirm the diagnosis. The barium stops at the upper end of the rectum, and the tip is bird-beak-like or conical spiral narrow, which can confirm sigmoid colon torsion. Cecal volvulus shows that the barium is blocked in the transverse colon or liver area.