Volvulus: causes, symptoms in adults and children, emergency care

Inversion – option of mechanical intestinal obstruction. Develops as a consequence of the local torsion of the section of intestine with mesentery, on which it is mounted. The twisting angle and direction can be different. As a result of this change, complaints and clinical manifestations of the problem.

They are caused by the duration and volume of detainees bolus, squeezing vessels and nerves. These changes lead to the death of cells and tissues of the affected gastrointestinal tract.

Necrosis of the walls can cause their separation, which is the cause of the ingress of the bolus in the abdominal cavity and cause severe complications – fecal peritonitis. Volvulus is an emergency surgical condition requiring immediate treatment of patients.

Without medical intervention, the patient may die.

Causes of volvulus

To the development of pathology predispose:

• elongation of the intestines for various reasons (or parts thereof);
• excessive growth of the mesentery, scar defects in its root constriction;
• congenital abnormality leading to the straightening of the line of fixation of the mesentery to the divisions of the digestive tract;
• adhesions;
• pokerengine and post-inflammatory adhesions;
• tumors;
• the activity of the parasites;
• excessive and rapid loss of body weight, leading to giperpoverkhnosti the intestinal loops;
• dysentery, inflammation, frequent constipation.

Reasons giving impetus to the process (i.e. factors):

• a sharp and sudden increase in intra-abdominal pressure;
• increased motility (peristalsis) of the gastrointestinal tract;
• receiving an excessive amount of food through long periods of time (overeating). Especially if the food is gross. Overeating causes an overflow of the lumen, increased flatulence, and displacement of the intestinal loops;
• traumatic injury of the abdomen.

Dangerous on twists 180-360° and more.

Types of inversion

Depending on the plot, which can develop pathology, distinguish the pathological process:

• thin;
• blind;
• poperechnopolostah;
• sigmoid colon.

The most common classification includes the basic clinical types of pathology. Diagnosis is important for choice of tactics of treatment.

The symptoms of volvulus

Even the slightest suspicion of evolving intestinal obstruction require mandatory inspection by a specialist surgeon.

If the patient is experiencing the following signs, immediately call requires an ambulance.

Volvulus of the small intestine

Practical observations of abdominal surgeons (dealing with diseases of the abdominal organs) indicate that this form of obstruction began to meet much less frequently than before. The process develops in the direction of clockwise and always wears a heavy character. It is due to the length of the involved Department and large angles (number) of rotation. Sometimes the inversion gets the entire small intestine.

Patients complain of:

• discomfort with heaviness in the abdomen, loss of appetite, diarrhea (in the prodromal period – the initial phase);
• sudden sharp pain attacks, which greatly lessens or completely go away with conservative methods of care;
• forced position. The patient often lies on back or side, restless. The legs tightens to the stomach. Sometimes a person adopts the knee-elbow position. In these positions, the pain is felt less intensely;
• reflex vomiting adopted by the food, the frequency and intensity of which increases. Prolonged delay in seeking medical attention it takes fecal character;
• the constipation, absence of feces;
• pronounced weakness, headache, palpitations, high body temperature, caused by intoxication and poisoning.

On examination, the doctor discovers a distended belly, lack of normal peristalsis. Percussion (tapping the abdominal wall), the specialist determines brunacini effusion. Against this background, auscultatory noise in my stomach is replaced by ‘silence’.

The symptoms of volvulus of the cecum

This kind of disease is quite rare.

There are three subspecies:

• blind inversion with the common iliac mesentery;
• around the longitudinal axis;
• about a transverse axis.

During the formation of obstruction in patients periodically marked cramping pain, tendency to constipation, the bowels often swells.

Peculiarities of complaints and symptoms:

• pain syndrome more and more noted in the right abdomen;
• there is a clear asymmetry of the abdominal wall (due to determined when the feeling of distention of the cecum);
• the doctor establishes the presence of a symptom Valya and splashing, symptom Schiemann – Dance (cavities in the area of the ileocecal angle, due to the displacement of the cecum).

Frequent diagnostic errors due to similarities of symptoms of obstruction with signs of appendicitis.

Volvulus of the colon poperechnopolostah

The pattern of complaints in this process is nonspecific and may appear rather diverse. Level problems allow you to set only the x-ray diagnostics.

The symptoms of volvulus of the sigmoid colon

The most frequent variant of the disease. In its development plays a great importance to the presence of congenital and acquired abnormalities in the structure of this section of the gastrointestinal tract, particularly increased length, scarring.

Clinic can occur in acute and subacute (less severe complaints).

Distinctive features:

• pain and Velikobritanii contour of the affected intestine is clearly localized on the left, there is a “lopsided” abdomen;
• symptom Kivala – high-pitched percussion (tapping the abdomen on the left), giving a mechanical hue. Symptom of Wilms “falling drops”, Latisana pronounced noises when breathing and heartbeat. If you try to do an enema in the intestine is more than 500 ml of fluid (symptom Tsege-Mantarays).

Diagnosis

When the diagnosis of a doctor is based upon:

Radiographic signs are manifested by the presence of swollen intestine with a kind of “bowls”, pronounced austrumi and is characterized by a wide level of fluid (sometimes up to 20 cm). Marked delay in the passage of barium.

Specific interpretaci studies with barium are observed in the volvulus of the sigmoid colon.

The survey allows to identify the 3 degrees of the process:

1. Inversion by 180°. The contrast reaches rectosigmoidal segment of the intestine, forming a “beak.” According to his direction can determine the direction Zavorotnaya. If the beak of the left colon to the right and Vice versa.
2. 360°. On the monitor, or the picture is clearly monitored by penguin.
3. More than 360°. Contrastives only a smaller piece of intestine.

Changes in blood:

• pronounced leukocytosis;
• accelerated erythrocyte sedimentation rate;
• the decrease in the number of red blood cells;
• lower values of hemoglobin.

Treatment of volvulus

When the first suspicions of the disease should immediately consult a doctor. The patient should be put, do not feed or give to drink. Alone do not induce vomiting and do not attempt to set up the enema. Pain relievers should not be given as they can “erase” the signs of the disease and lead to diagnostic error in medical examination.

The patient is urgently needed to deliver in the surgical Department of the hospital.

Conservative treatment can help only in cases of the initial stages of the low option of sigmoid volvulus. In all other cases required surgical intervention.

Surgery

After diagnosis and before surgery, you should try to help the patient.

To do this:

• assigned to infusion solutions for removal of intoxication and recovery of circulating blood volume;
• is adequate pain relief prescription drugs, if necessary – narcotic analgesics;
• in case of possible efficiency washed out the stomach and put enema.

Peculiarities of surgical interventions

In connection with the serious condition of the patient and volume of exposure to the patient necessarily is anesthetized (General anesthesia).

Surgical access to correct volvulus is carried out using a wide laparotomies incision from the xiphoid process, the rounding of the belly button on the left to the pubic area. To the blind and the sigmoid colon enough nizhneserginskogo access.

The nature of the operation depends on the anatomical damage. In the period of early changes common enough straightening twists. Against this background, quickly restores normal circulation and peristalsis. Eyes the surgeon the bowel turns pink, begins to decline. Detection of adhesions requires its dissection.

Necrotic tissue changes (darkening), dullness, presence of bloody effusion requires the removal (resection) of the affected area.

In the case of volvulus of the cecum, it is fixed with a flap visceral peritoneum (celopeci) with shortening of the mesentery. Another way of corrugated scopical offers strengthen ligaments joints. Some patients are advised retroperitoneal immobilization. In this case the cecum and ascending colonic division sutured to the parietal peritoneum.

With gangrene and peritonitis, the affected area is excised, and the ends of the intestine are displayed on the surface of the abdominal wall in the form of “shotgun”. This technique is called an ileostomy. After the medical events assigned to the second phase of the operation to restore integrity of the gut.

Postoperative period

In view of the difficult surgical exposure patients quite a long time away from operations.

They need:

• a special diet;
• pain relief;
• bed and polupostelny mode;
• medical and respiratory gymnastics;
• physiotherapy services.

The risk of volvulus in children

A children’s version refers to very dangerous conditions in Pediatrics. Even at the slightest suspicion on the development of this disease in a child requires immediate medical consultation. Late the provided help leads to a high percentage of deaths.

What are the risks of volvulus during pregnancy

Any form of this variant of intestinal obstruction is fraught with serious consequences. A pregnant woman needs immediate treatment to avoid serious complications and to preserve the life of the mother and child.

Prevention

Performing simple recommendations will significantly reduce the risk of occurring acute illness.

For the prevention of disease requires:

• adhering to a balanced diet. Should avoid overeating, eat a balanced;
• to treat the disease, leading to constipation;
• to observe active motor mode to eliminate stagnant phenomena in abdominal cavity;
• undergo periodic testing and treatment from specialists-gastroenterologists at pathologies of gastrointestinal tract.

Intestinal volvulus refers to a serious surgical pathologies and requires mandatory participation of a specialist. In case of rendering assistance in time a chance to recover without consequences for the organism is much higher.