Twisted bowel (volvulus) in adults: How the bowels twist and how to treat it

Having a twisted bowel is like having a twist or loop that results in the obstruction of fecal matter moving through the intestines. The medical term for the condition is termed volvulus and it can occur in the small or large intestine. It may be referred to as small bowel volvulus or colonic volvulus respectively. Where the twist and obstruction are located will dictate the presentation of the condition.

In humans, the bowels consist of the small and large intestine. The small intestine is further divided into the jejunum, duodenum, and ileum, and the large intestine is divided into the cecum, rectum, and colon

The most worrisome issue with a twisted bowel is that if the abnormality is not fixed in time, necrosis or cell death will occur 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 be the result of a primary cause occurring in the abdominal cavity or more commonly due to a secondary cause such as due to an anatomic malformation, adhesions, tumors, or diverticula.

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 developing a twisted bowel.

The answer to what causes 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.
• Over eating: 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 and looks 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 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.
• 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 particular underlying cause, with levels of severity also varying. 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.

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 with 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 over time for the bowel to move back into its normal position. 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.

Prognosis of volvulus

Waiting too long in diagnosing and treating 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. Even when volvulus is adequately treated with endoscopic decompression and surgical resection, mortality is in the range of 12–15 percent, according to various studies. As many as 50 percent of patients who undergo endoscopic decompression alone experience recurrence. Endoscopic decompression alone for sigmoid volvulus is seen to carry a recurrence rate of 40-50, with a mortality of 25-30 percent after surgical treatment of the recurrent volvulus.

Related: Bowel obstruction (intestinal obstruction): Causes, symptoms, diagnosis, and treatment