Acute volvulus

Introduction Intestinal torsion: intestinal obstruction caused by a long mesentery of the mesentery twisted 180° or more. Intestinal torsion occurs when the movement of the intestines is abnormal or the contents of the intestines increase and the position is suddenly changed. Such as relatively free cecum, small intestine and sigmoid colon are good sites. Young adults and children are more common. Sudden onset, severe abdominal pain, umbilical cramps often involve the lower back, often persistent paroxysmal aggravation. The patient bends and bends to relieve the pain, and the abdomen can lick the swollen intestinal tract. Intestinal strangulation and intestinal necrosis often occur in a short period of time. If it is not diagnosed and treated in time, it is prone to shock, and the mortality rate is 15% to 40%.

Cause

Strenuous exercise after a meal or a sudden change in body position.

The cause of primary bowel torsion is unclear and there is no anatomical abnormality. It may be that after the meal, there is more undigested content in the intestine. When there is obvious movement of body position, the small intestine cannot be weighted due to sagging. This is caused by synchronous rotation.

Secondary volvulus is due to an anatomical change obtained in congenital or acquired, and a fixed point appears to form the axis of the intestinal fistula. However, the occurrence of intestinal torsion is often the same as the following three factors:

Anatomical factor

The mesentery that reverses the intestinal fistula is too long, and the mesenteric root adheres to the posterior retroperitoneum because of congenital development or adhesion contraction. Therefore, the most common sites are small intestine, transverse colon, sigmoid colon and cecal with high mobility. Adhesions after surgery, Meckel's diverticulum, sigmoid colon length, congenital middle colonic insufficiency, free cecum, etc., are the anatomical factors of intestinal torsion.

2. Physical factors

On the basis of the above-mentioned anatomical factors, the intestinal weight capacity is increased and the intestinal peristalsis is enhanced. For example, after a full meal, more non-digestible foods are poured into the intestinal lumen; or there are more mites in the intestinal lumen; The tumor, in the sigmoid colon, the village is in a hurry to dry up a lot of feces, etc., are all potential factors for intestinal torsion.

3. Dynamic factors

A strong peristalsis or sudden change in body position causes an unsynchronized movement of the intestinal fistula, causing the existing axis to be fixed and the intestines with a certain weight to be twisted.

an examination

(1) small intestine torsion: abdominal cramps, sudden occurrence, mostly located around the umbilicus, often tumbling in bed due to unbearable pain. Pain and radiation to the lower back, accompanied by vomiting, the patient was pale, the pulse was weak, and even shock occurred. Check: Abdominal tenderness, abdominal muscle tension, and bowel sounds.

(2) sigmoid colon torsion: paroxysmal paroxysmal abdomen, obvious abdominal distension, less pain, slightly less intestinal torsion, vomiting is not obvious. Often older men with a history of constipation. Check: Abdominal bulging, bowel sounds hyperthyroidism. X-ray abdominal obstruction above the intestinal fistula significantly dilated, barium enema examination, visible torsion barium obstruction blocked, the shadow tip is bird's mouth.

Differential diagnosis

The typical clinical manifestation of acute appendicitis is a gradual pain in the upper abdomen or around the umbilicus. After a few hours, abdominal pain is transferred to the lower right abdomen. Often accompanied by loss of appetite, nausea or vomiting, in addition to low fever, fatigue, no obvious systemic symptoms. Acute appendicitis can be developed into appendical gangrene and perforation if it is not treated early, with limited or diffuse peritonitis. Acute appendicitis has a mortality rate of less than 1%, and the mortality rate after diffuse peritonitis is 5 to 10%.

(1) small intestine torsion: abdominal cramps, sudden occurrence, mostly located around the umbilicus, often tumbling in bed due to unbearable pain. Pain and radiation to the lower back, accompanied by vomiting, the patient was pale, the pulse was weak, and even shock occurred.

Check: Abdominal tenderness, abdominal muscle tension, and bowel sounds.

(2) sigmoid colon torsion: paroxysmal paroxysmal abdomen, obvious abdominal distension, less pain, slightly less intestinal torsion, vomiting is not obvious. Often older men with a history of constipation.

Check: Abdominal bulging, bowel sounds hyperthyroidism. X-ray abdominal obstruction above the intestinal fistula significantly dilated, barium enema examination, visible torsion barium obstruction blocked, the shadow tip is bird's mouth.

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