University of California San Francisco

Volvulus (Twisting of the Colon)

Volvulus occurs when the intestine twists around itself and the mesentery that supports it, creating an obstruction. The area of intestine above the obstruction continues to function and fills with food, fluid, and gas. The mesentery may become so tightly twisted that blood flow to the affected part of the intestine is cut off. This situation can lead to death of the blood-starved tissue and tearing of the intestinal wall—a life-threatening event and a medical emergency.

Volvulus can be caused by malrotation or by other medical conditions such as

  • an enlarged colon
  • Hirschsprung disease, a disease of the large intestine that causes severe constipation or intestinal obstruction
  • abdominal adhesions, or bands of scar tissue that form as part of the healing process following abdominal injury, infection, or surgery

Sigmoid volvulus—twisting of the sigmoid colon—accounts for the majority of cases, with cecal volvulus—twisting of the cecum and ascending colon—occurring less frequently.

Sigmoid Volvulus

Anatomic problems that increase a person’s risk of developing sigmoid volvulus include

  • an elongated or movable sigmoid colon that is not attached to the left wall of the abdomen
  • a narrow mesentery connection at the base of the sigmoid colon
  • malrotation that presents with problems in infancy

Sigmoid volvulus that occurs after infancy is more commonly seen in people who

  • are male
  • are older than age 60
  • live in a nursing or psychiatric facility
  • have a history of mental health conditions

Symptoms of Sigmoid Volvulus

Sigmoid volvulus symptoms can be severe and occur suddenly. Symptoms may include

  • abdominal cramping
  • bloody stools
  • constipation
  • nausea
  • signs of shock
  • vomiting

People with any of these symptoms should be evaluated immediately by a health care provider.

Other symptoms may develop more slowly but worsen with time, such as constipation, inability to pass gas, and abdominal swelling. People with these symptoms should also contact a health care provider.

Diagnosis and Treatment of Sigmoid Volvulus

Prompt diagnosis and appropriate treatment of sigmoid volvulus generally lead to a successful outcome. Doctors use x rays, upper or lower GI series, CT scans, and flexible sigmoidoscopy—another common diagnostic test—to help diagnose sigmoid volvulus.

  • Flexible sigmoidoscopy. This test is used to look inside the rectum and lower colon. Sigmoidoscopy is performed at a hospital, outpatient center, or doctor’s office by a gastroenterologist—a doctor who specializes in digestive diseases—or a radiologist. Infants and children may be given a sedative to help them fall asleep for the test. For the test, the person will lie on a table while the doctor inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The doctor can see sigmoid volvulus.

    Children and adults can usually go back to their normal diet after the test, though cramping or bloating may occur during the first hour after the test.

If volvulus is found, the doctor may use the sigmoidoscope to untwist the colon. However, if the colon is twisted tightly or if the blood flow has been cut off, immediate surgery will be needed. Surgery involves restoring the blood supply, if possible, to the affected part of the sigmoid colon. Sometimes the affected part of the colon must be removed and the healthy ends reattached, a procedure called an intestinal resection. Resection prevents volvulus from recurring; untwisting the volvulus with the sigmoidoscope may not prevent recurrence.

Cecal Volvulus

Cecal volvulus is twisting of the cecum and ascending colon. Normally, the cecum and ascending colon are fixed to the abdominal wall. If improperly attached, they can move and become twisted.

Symptoms of Cecal Volvulus

More commonly seen in people ages 30 to 60, cecal volvulus may be caused by abdominal adhesions, severe coughing, or pregnancy. People with cecal volvulus often have intermittent chronic symptoms—those that come and go over a longer period of time—including

  • abdominal cramping or swelling
  • nausea
  • vomiting

People with any of the above symptoms should be evaluated immediately by a health care provider.

Other symptoms may develop more slowly but worsen with time, such as constipation, inability to pass gas, and abdominal swelling. People with these symptoms should also contact a health care provider.

Diagnosis and Treatment of Cecal Volvulus

Doctors use x rays, upper or lower GI series, and CT scans to diagnose cecal volvulus. Imaging shows whether the cecum is out of place and inflated with trapped air. Imaging may also show that the appendix, which is attached to the cecum, is filled with air. To treat cecal volvulus, surgeons use a procedure called cecopexy to reposition the cecum and attach it to the abdominal wall. If the cecum is seriously damaged by volvulus, the surgeon will perform intestinal resection surgery. Cecopexy and intestinal resection surgery have high rates of success and usually prevent the recurrence of cecal volvulus.