The colon, a part of the large intestine, absorbs water and forms stool. When this organ twists abnormally, it’s called a “twisted colon” or volvulus. This twisting can block the intestine, disrupting normal function and potentially cutting off blood supply. Prompt medical attention is necessary.
What is a Twisted Colon?
A twisted colon, or volvulus, occurs when a segment of the intestine rotates around itself and the mesentery. The mesentery is the tissue that attaches the intestine to the abdominal wall, providing blood supply to the bowel. This twisting creates a closed-loop obstruction, preventing the passage of food, fluid, and gas.
The most common locations for volvulus in adults are the sigmoid colon and the cecum. Sigmoid volvulus involves the twisting of the S-shaped part of the large intestine closest to the rectum. Cecal volvulus refers to the twisting of the cecum and ascending colon, at the beginning of the large intestine. The tight twisting can also compromise blood vessels within the mesentery, leading to a lack of blood flow, known as ischemia, to the affected bowel segment.
Recognizing the Signs
A twisted colon presents with symptoms ranging from sudden onset to gradual worsening. Severe abdominal pain is common, often described as sudden and crampy. This pain arises because the twisted bowel causes pressure and injury to the intestinal wall, accumulating gas and fluid.
Individuals may experience abdominal distension, a noticeable swelling of the belly, along with nausea and vomiting. Vomiting can appear bilious, a greenish-yellow fluid. Constipation and the inability to pass gas are frequent symptoms due to the bowel obstruction. Bloody stools may occur, indicating potential damage to the intestinal lining.
Causes and Risk Factors
Several factors can contribute to a twisted colon, including anatomical predispositions, medical conditions, and lifestyle habits. Anatomical variations, such as an unusually long or redundant colon or a narrow mesentery connection, can make the intestine more prone to twisting. These features are more commonly observed in older adults.
Chronic constipation is a risk factor, particularly for sigmoid volvulus, as it can lead to an enlarged and overloaded colon susceptible to twisting. Certain medical conditions also increase the risk, including Hirschsprung’s disease, which affects nerve cells in the large intestine, and abdominal adhesions, bands of scar tissue often formed after prior abdominal surgery or infection. Age plays a role, with sigmoid volvulus more frequent in older adults, while midgut volvulus, affecting the small intestine, is more common in infants. Neuropsychiatric disorders and reduced mobility can also increase susceptibility, often due to associated chronic constipation.
Diagnosis and Treatment Approaches
Diagnosing a twisted colon involves medical history review, physical examination, and imaging studies. During a physical exam, a healthcare provider checks for abdominal tenderness, distension, and listens for bowel sounds. Imaging tests confirm the diagnosis and pinpoint the twist’s location.
Abdominal X-rays can reveal characteristic signs, such as dilated loops of bowel or a “coffee bean” sign in sigmoid volvulus. Computed tomography (CT) scans provide detailed images, often showing a “whirl sign” indicating the twisted mesentery. Barium enemas or upper gastrointestinal series can also visualize the obstruction.
Treatment aims to relieve the obstruction and restore blood flow. Non-surgical approaches, such as endoscopic detorsion using a sigmoidoscope or colonoscope, can untwist a sigmoid volvulus by inserting a flexible tube through the rectum. If twisting is severe, or non-surgical methods fail, surgery becomes necessary. Surgery may involve a laparotomy, where an incision is made in the abdomen to untwist the bowel. If the affected bowel segment is damaged, it may need removal in a bowel resection, with healthy ends reattached. In severe cases, a colostomy, which diverts waste to an external bag, might be required.
Potential Complications
If a twisted colon is not diagnosed and treated promptly, it can lead to several severe complications. A complete bowel obstruction is a direct consequence, preventing the passage of intestinal contents. The twisting can also cut off blood supply to the affected segment, leading to ischemia, where tissue death or necrosis occurs.
When tissue dies, it can weaken the intestinal wall, leading to a perforation, a hole in the bowel. This allows intestinal contents to leak into the abdominal cavity, causing peritonitis, a serious infection and inflammation of the abdominal lining. Peritonitis can progress to sepsis, a widespread, life-threatening infection, and shock, a critical condition characterized by inadequate blood flow. If a significant portion of the bowel is severely damaged and removed, short bowel syndrome may occur, affecting nutrient absorption.