volvulus (small intestine)
Last reviewed 01/2018
Volvulus of the small intestine may occur when a loop of intestine is fixed at its apex e.g. by adhesions or by a Meckel's diverticulum remnant. Rarely the apex of the volvulus may be a tumour. Congenital mal- or non-rotation is another rare cause.
Primary volvulus of the small bowel is relatively common in Africa. This may be due to the different diet where a significant amount roughage is consumed. This may cause loading of a loop of gut with large quantities of vegetable foodstuffs and result in volvulus. The condition is rare in the West.
The clinical picture is one of acute intestinal obstruction: severe central abdominal pain. Hypovolaemia may occur due to venous pooling; urgent resuscitation is required before operative untwisting of the volvulus. If untwisting is not possible and bowel is infarcted, the affected segment needs to be resected.