- Richard A Hodin, MD
Richard A Hodin, MD
- Professor of Surgery
- Harvard Medical School
Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. The most common sites of volvulus are the sigmoid colon and cecum [1-4]. Volvulus of other portions of the alimentary tract, such as the stomach, gallbladder, small bowel, splenic flexure, and transverse colon, are rare.
This topic will review the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of sigmoid volvulus. The clinical manifestations and diagnosis of cecal volvulus are discussed separately. (See "Cecal volvulus".)
The incidence of sigmoid volvulus is not well established (picture 1). In the United States, sigmoid volvulus is a relatively uncommon cause of intestinal obstruction, representing fewer than 10 percent of cases in most series [1,5]. In contrast, sigmoid volvulus is the underlying etiology in 50 to 80 percent of patients with intestinal obstruction in other parts of the world [6-10]. (See "Chagas disease: Pathology and pathogenesis".)
Sigmoid volvulus usually occurs in older adults with a mean age of 70 years at presentation . Patients are often institutionalized and debilitated due to underlying neurologic or psychiatric disease and have a history of constipation [11-14]. Sigmoid volvulus has been reported in younger patients and in children in association with abnormal colonic motility [15-20]. (See 'Colonic dysmotility' below.)
Although some series have reported a predominance in men, others have found no difference in incidence by gender [4,13,21]. A longer sigmoid colon and mesentery in males (especially in black Africans) could be the reason for an increased likelihood of volvulus [22,23]. Sigmoid volvulus has been reported in patients with Crohn disease, pregnancy, and Chagas disease [8,24-26].
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