volvuli

Volvuli are plural instances of volvulus, a condition in which a loop of bowel twists around its mesentery. This twisting creates a closed-loop obstruction that can rapidly compromise venous outflow and, if not relieved, arterial blood flow, risking ischemia and bowel necrosis. The term derives from Latin and is used to refer to multiple twisting events rather than a single occurrence.

The most common sites for volvuli are the stomach (gastric volvulus), the sigmoid colon, and the cecum, with the midgut in children who have malrotation also susceptible. Sigmoid volvulus is the most frequent type in the elderly and in institutionalized populations, while cecal volvulus tends to occur in younger adults. Gastric volvulus is relatively rare but can present with acute obstruction or chronic intermittent symptoms. In infants and children, midgut volvulus related to malrotation is a surgical emergency.

Clinical presentation varies by location. Gastric volvulus may cause abrupt upper abdominal pain, retching, and inability to pass a nasogastric tube (Borchardt’s triad). Sigmoid and cecal volvulus typically present with progressive abdominal distension, crampy pain, nausea or vomiting, and obstipation. In malrotation-associated midgut volvulus, bilious vomiting and rapidly evolving distress are common.

Diagnosis relies on imaging. Plain radiographs can show abnormal gas patterns or distension; the sigmoid is often described as having a “coffee-bean” sign, while CT can reveal bowel twist and mesenteric whirl. Upper GI studies or endoscopy may be useful in gastric volvulus to confirm diagnosis and sometimes treat decompression.

Treatment is typically urgent. Detorsion is performed when possible; nonviable bowel requires resection. Additional procedures may include fixation of mobile segments (gastropexy or colectomy) and, for malrotation, Ladd’s procedure. Prognosis improves with rapid diagnosis and prompt surgical management.