Volvulus

Abstract

The term volvulus refers to the twisting of an organ along a pedicle. This can involve nearly any portion of the gastrointestinal tract and even other organs such as the gallbladder and spleen. Colonic volvulus is a relatively uncommon condition, but can lead to vascular congestion. When left untreated, this can progress to ischemic necrosis and perforation. Therefore, it warrants immediate identification and treatment. The cecum and sigmoid colon are the most common portions of the large intestine affected by volvulus (Ballantyne, Ann Surg 202:83–92, 1985; Friedman, Dis Colon Rectum 32:409, 1989). It is important for the acute care surgeon to readily recognize each condition and be aware of the proper treatment plan. Colonic volvulus has been described for thousands of years. The Papyrus Ebers, written around 1500 BC, described the “rotting” of the colon unless spontaneous reduction occurred. It was later recognized that reduction of the volvulus could be induced by either placement of a rectal tube or with passage of air into the rectum. Hippocrates described each method, including the passage of a 22 cm suppository to produce detorsion (Ballantyne, Dis Colon Rectum 25:494–501, 1982). It was in the nineteenth century that Gay performed a cadaver study in which he found that the insertion of a rectal tube could produce detorsion of a sigmoid volvulus.