A volvulus -- in this case occurring in childhood -- is a twisting of the bowel with obstruction of the flow of material through the bowel, variable loss of blood supply, and possible tissue death.

Volvulus is defined as a complete twisting of a loop of intestine around its mesenteric attachment site. Such twisting can occur at various sites of the GI tract, including the stomach, small intestine, cecum, transverse colon, and sigmoid colon. Midgut volvulus refers to twisting of the entire midgut about the axis of the superior mesenteric artery. This article mainly concerns midgut volvulus because it is the most common and is a very serious type of volvulus in infants and children.

The signs and symptoms of volvulus may include, but are not limited to, the following:

• Abdominal pain
• Constipation
• Blood in stool
• Nausea

Twisting in volvulus may result from an anomaly of rotation, an ingested foreign body, or an adhesion; in some cases, however, the cause is unknown. Volvulus usually occurs in a bowel segment with a mesentery long enough to twist. The most common area, particularly in adults, is the sigmoid; the small bowel is a common site in children. Other common sites include the stomach and cecum. Volvulus secondary to meconium ileus may occur in patients with cystic fibrosis.

Volvulus often has a sudden onset. The symptoms and signs may include abdominal pain, nausea, vomiting, and blood in the stool. The treatment is surgery to free the obstruction and ensure normal blood flow to the bowel. Volvulus is a surgical emergency.

Emergency surgery to repair the volvulus is necessary. An incision is made in the abdomen, the bowels are inspected, and the volvulus is reduced. This means that the bowels are untwisted and the blood supply restored.

If a small segment of bowel is necrotic (dead from lack of blood flow), it is removed and the ends of the bowels sewn back together, or used to form a colostomy or ileostomy (tube to the outside through which bowel contents can be removed -- the term depends on where the tube is formed). If the entire bowel is necrotic, the outlook is poor, and the situation may be fatal.

A volvulus is usually surgically repaired as soon as possible. The intestine is untwisted and checked for damage. Ideally, the circulation to the intestine will be restored after it is unwound, and it will turn pink.

If the intestine is healthy, it is replaced in the abdomen. Since the appendix is located in a different area than usual, it would be difficult to diagnose appendicitis in the future; therefore, an appendectomy (surgical removal of the appendix) is also usually performed.

Decompression:

With the patient in the left lateral position, decompression and untwisting of the sigmoid loop may be achieved by passing a sigmoidoscope gently into the rectum as far as possible and a flatus tube passed through it. This is then gently manoeuvred into the obstructed loop through the twisted bowel producing a rush of liquid faeces and flatus with relief of the obstruction.