Colon volvulus is an abnormal twisting within the gastrointestinal tract that can impair blood flow.

Most cases occur in the sigmoid colon, the S-shaped last part of the large intestine that leads to the rectum. When the twisting happens here, it is called sigmoid volvulus.

Less frequently, the twisting occurs in the cecum, which is the pouch that connects the small and large intestines and ascending colon. This is called cecal volvulus.

Colon volvulus usually occurs suddenly. The area above the twist continues to work and fills with food, fluid and gas. However, below the twist, blood-starved tissue can die or tear, creating a life-threatening medical emergency.

What causes the intestine to twist?

Volvulus is most commonly caused by a birth defect called malrotation, when the bowel becomes misaligned during fetal development.

Colon volvulus symptoms

Potential symptoms of colon volvulus include sudden:

• Abdominal pain
• Nausea
• Vomiting
• Blood in the stool

Colon volvulus diagnosis

Prompt diagnosis is important.

• Testing for sigmoid volvulus may involve X-rays, CT scans or other imaging of the upper or lower gastrointestinal (GI) tract, as well as flexible sigmoidoscopy, which uses a lighted, flexible tube called an endoscope to look inside your rectum and colon. A small camera then sends a video image of the intestinal lining to a computer screen for a close view of the affected area.
• Cecal volvulus can be also diagnosed with imaging of the upper or lower GI. These tests will show whether the cecum is out of place and inflated with trapped air.

Colon volvulus treatment

Colon volvulus is a surgical emergency that requires immediate repair to return normal blood flow.

• For sigmoid volvulus, the doctor may use a sigmoidoscope to untwist the colon; the volvulus may or may not recur. In some cases, an intestinal resection is needed. With this, the doctor removes the damaged part of the colon and reattaches the healthy ends. This can prevent volvulus from recurring.
• For cecal volvulus, a procedure called cecopexy will reposition the cecum and attach it to the abdominal wall. If the cecum is seriously damaged, intestinal resection surgery will be performed. Both of these procedures have high success rates and generally prevent recurrence.