Volvulus

Introduction to small bowel torsion Small intestine torsion means that the small intestine tendons are twisted more than 180° clockwise or counterclockwise along the longitudinal axis of the mesentery, so that both ends of the torso-intestinal fistula and the mesenteric vessels are compressed, and the intestines are completely or partially occluded and dysfunctional. A closed strangulated intestinal obstruction is formed. The torsion may be complete or incomplete. The latter may recover spontaneously or may become complete. The torsion may involve part of the small intestine or all small intestines, and is also common in the sigmoid colon. The torsion causes the mesangial to be narrowed, first compressing the vein, and refluxing. Obstructed, tissue congestion and edema; then arterial blood supply disorders, early intestinal tube swelling, purple, red color gradually dark, and finally become black, loss of elasticity and luster, and bloody exudation and odor, more bloody fluid in the intestine Mesenteric edema is thickened and may have bleeding. basic knowledge The proportion of illness: 0.0005% Susceptible people: no specific population Mode of infection: non-infectious Complications: ascites shock

Cause of small bowel torsion

Physiological factors (30%):

The anatomical abnormal mesenteric length and the mesentery are not fixed in the posterior abdominal wall, resulting in greater intestinal motility, more torsion, mostly congenital malformation, Meckal diverticulum in the small intestine, incomplete rotation of the small intestine, are the cause of intestinal torsion.

Congenital factors (30%):

There may be racial differences in congenital anomalies. At least the incidence rates in different countries are significantly different. For example, the former Soviet Union, Finland, and Poland are more common, while the United Kingdom and the United States are rare. For example, congenital small intestine rotation is abnormal, and the distance between the two ends of the intestinal fistula is abnormal due to anatomy. Inflammatory rough and too short, the mesentery is caused by inflammatory adhesions, and the root of the mesentery is narrowed. The intestinal fistula is fixed at a certain point in the abdomen due to the adhesion of the cord, which may also cause the intestinal fistula to be twisted.

Predisposing factors (30%):

Mainly due to the obstructive factors caused by the gravity of the intestinal fistula or the sudden change of body position. In China, the incidence of midgut torsion in rural areas is high, which is related to excessive cellulose and postprandial labor in food. Increased weight, promote bowel movements, and participate in intense labor immediately after a meal. When the body leans forward, the gills drooping due to gravity rotates in a certain direction to produce a slight twist. When the body suddenly stands upright, the mesentery continues due to inertia. Rotation and aggravation of the degree of torsion can produce acute complete volvulus, excessive fiber residue in the food, and a significant increase in weight in the intestinal lumen due to accumulation of constipation and mites.

Small intestine torsion on the occurrence of intestinal obstruction depends on the length of the affected intestinal fistula, such as the shortened intestinal fistula is short, the lumen is very easy to obstruct; the twisted intestinal fistula is longer, the twist of the intestinal fistula is not obvious, and there is no obstructive symptoms.

Pathogenesis

Children with small bowel obstruction are mostly caused by intestinal malformation; adult patients are often secondary to certain pathological basis, such as local adhesion after surgery, mesenteric tumor, long mesangial, etc., small intestine torsion is more clockwise , usually more than 270 °, whether there is intestinal obstruction after the occurrence of small bowel torsion is also related to the degree of twisted intestinal fistula and the degree of torsion. In general, the twisted intestinal fistula is more prone to obstruction, and the intestine When the sputum is long, it usually needs to be twisted 180°~360° to cause obstruction. After the small intestine torsion, the mesentery will also be reversed, the mesenteric blood vessels will be twisted and oppressed, affecting the blood supply of the intestinal fistula, and the intestinal perforation is easy. And peritonitis.

Small bowel prevention

Strengthen publicity of health knowledge, warn people to avoid physical labor immediately after eating a meal, patients with habitual constipation, especially the elderly, should try to laxative and develop regular bowel habits, for intestinal ascariasis, megacolon, etc., should be given Early treatment.

Small intestine torsion complications Complications ascites shock

Ascites may occur in the late stage of small intestine torsion, and peritoneal irritation and shock.

Small bowel torsion symptoms Common symptoms Abdominal distension and abdominal pain accompanied by nausea, vomiting, constipation, nausea, fecal vomit, shock, fecal impact, intestinal tract intussusception

Small intestine torsion is characterized by acute mechanical intestinal obstruction, often induced by strenuous activity after eating. In children, it is often associated with congenital intestinal malrotation, which is characterized by sudden onset of severe abdominal cramps, mostly around the umbilicus. Often, persistent pain is aggravated; abdominal pain is often involved in the lower back, patients often do not dare to lie flat, like chest or knee or distorted lateral position; frequent vomiting, early abdominal distension is not obvious, tenderness is light, no obvious abdomen Muscle tension and rebound tenderness, can not have high sputum bowel sounds, over time, abdominal distension is obvious and gradually increased, sometimes asymmetrical bloating, abdominal tenderness and muscle tension, the abdomen sometimes cramps and tenderness of the dilated bowel.

Small bowel reversal

1. Abdominal X-ray film

It can be seen that the small intestine is generally flatulent and has multiple fluid levels, sometimes visible pseudo-tumor signs, wheel-like or petal-like small intestinal shadows or empty, ileal transposition, but if the whole small intestine is twisted, it may only see the stomach and duodenum flatulence, Intestinal gas accumulation is not obvious, or only occasionally a small liquid level.

2. Ultrasound examination

Color Doppler ultrasound can be characterized by small bowel torsion:

1 small intestine, duodenum and stomach dilatation, filled with liquid or liquid-based contents.

2 The position of the blood vessels in the mesenteric roots is shown by the veins "enveloping" the superior mesenteric artery, and the color Doppler examination shows a "vortex sign" in the clockwise direction.

3 intestinal peristalsis is weakened or still.

4 The dark area of free liquid in the peritoneal cavity or the dark area of the original liquid increased rapidly.

5 The blood flow signal in the intestinal wall is reduced, especially the arterial signal disappears.

3. Selective mesenteric angiography

Small bowel torsion diagnosis generally does not use angiography, and occasionally for superior mesenteric artery angiography for other reasons, such as the artery or obstruction without flaws, the arteries are twisted into a circle with the mesentery.

4.CT scan

Typical cases show closed intestinal obstruction, intestinal dilatation of the closed fistula, obvious inflation, and a liquid level. According to the form of intestinal adhesion, the jejunum and ileum position can be judged to be replaced. At different levels, "C" shaped intestinal fistula may appear. "Coffee beans" sign, more intestinal fluids, can also appear "false tumor" sign, enlarge the intestinal wall thin, wrinkles and fine, showing a narrowing ischemic change, after the enhancement of the closed bowel tube such as twisting and narrowing, often intestine Insufficient or intensified wall strengthening, mesenteric edema, mesenteric venous return blocked and dilated, and the mesentery together with its blood vessels are entangled, distorted, and form a vortex, called "vortex" sign, due to less mesenteric venous return, more intestinal fluid leakage, so The inferior vena cava and superior mesenteric vein may slightly collapse, with small diameter and enhanced density.

5. Increased white blood cells: Leukocytes are significantly elevated (>15 × 109 / L) can appear early, which may be a stress response caused by intestinal ischemia.

Diagnosis of small intestine torsion

The disease is characterized by acute complete intestinal obstruction. Sudden and severe abdominal cramps appear after body position change, which may involve pain in the lower back. With the passage of time, abdominal distension is obvious and gradually intensified, sometimes with asymmetrical abdominal distension, abdomen. Tenderness and muscle tension, forced position, abdominal X-ray examination in line with the performance of strangulated intestinal obstruction, visible jejunal and ileal transposition, or arranged in a variety of small-span tortuous intestinal fistula and other signs, ultrasound and CT examination, visible Whirlpool sign."

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