Intestinal volvulus indicates the twisting of a loop of bowel around the axis of its own mesentery. Torsion of the loop of intestine is sufficient to produce intestinal obstruction and circulatory embarrassment of the involved intestine is one of most serious intra-abdominal catastrophies. The small intestine and the sigmoid colon are the organs most likely to be involved, as volvulus occurs most frequently in those organs, which are suspended from a narrow base and have a long, narrow mesentery. Fortunately this is infrequent. But when it does take place, the necessity of recognizing its development and of instituting proper therapy cannot be emphasized too strongly.
The incidence and the type of intestinal volvulus show marked geographical difference. Unfortunately in Korea, they were not unknown yet and there were only a few case reports.
In this regard, the author has reviewed 65 cases of intestinal volvulus which has been treated from Jan. 1971 to Dec. 1983 at Dept, of Surgery, College of Medicine, Jeonbug National University and Jeon ju Presbyterian Medical Center in Jeon ju, Korea.
The results are as follow;
1) The most frequent type of intestinal volvulus was volvulus of small intestine (54%) and followed by sigmoid volvulus (32%), compound volvulus (8%), cecal volvulus (5%) and transverse colon volvulus (1%).
2) The sex distribution of intestinal volvulus assumed a male-female ratio of 3 : 1. The incidence ratio of male and female was 3.4 1 in. volvulus of small intestine, 1.6: 1 in sigmoid volvulus. All patient [of cecal volvulus, transverse colon vblvulus and compound volvulus were male.
3) Of the age distribution, there was no age group in preponderence incidency of small bowel volvulus. In sigmoid volvulus, the peak incidence age group was 5 th and 7th decades and average age is 51.6 years. In compound volvulus the peak incidence and average age was 5th decades and 51.2 years. In cecal volvulus average was 35 years.
4) Intestinal volvulus was caused by anatomical abnormality or changes whether is conge-nital or acquired.
In the review of 35 cases of volvulus of the small intestine, the most important predispo-sing factor is previous abdominal operation (20 cases, 57%) and other factors are congenital
band (6 cases, 17%), congenital malrotation (3 cases, 9%). tumor (2 cases, 5%), intestinal hernia (1 case, 3%).
In the review of 21 cases of sigmoid volvulus, seventeen patients had redundant sigmoid loop, three patients had history of previous abdominal operation, one had been tuberculous peritonitis. Three cases were recurrent volvulus.
5) Duration of symptom from onset to admission was 2.5 days in average in the small bowel volvulus and was 3.2 days in average in the sigmoid volvulus.
6) The most common clinical symptom of volvulus of small intestine is nausea, vomiting (86%) and was followed by abdominal pain (77%), abdominal distention (60%), constipation or defecation difficulty (29%), back pain (17%), and in sigmoid volvulus is abdominal distention (76%), abdominal pain (67%), nausea vomiting (52%), constipation (29%).
7) The most commonest physical finding in volvulus of the small intestine was tenderness (83%) and were followed by abdominal distention (60%), fever (23%), peritoneal irritation sign (20%), and main physical finding of sigmoid volvulus was tenderness (81%), abdominal distention (70%), fever (240%), peritoneal irritation sign (24%).
8) Volvulus of the small intestine diagnosed with clinical manifestation and X-ray finding of the abdominal plain film were 9 cases of 35 cases. In 20 cases of 35 cases (57%), diagnosis were made after exploratory laparatomy as impression of mechanical small bowel obstruction. In 6 cases of 35 cases (17%), diagnosis were made only exploration. Sigmoid volvulus diagnosed with clinical manifestation and X-ray finding of the abdominal plain film were 13 cases of 21 cases (62%), sigmoidscopic examination was undergone in 9 cases of 21 cases and were diagnosed in 7 cases (33%). In 3 cases of ,21 cases (14%) diagnosis were made by barium enema. Cecal volvulus, compound volvulus and transverse colcon volvulus were only diagnosed with exploration.
9) Volvulus of the small intestine were treated all cases surgically. As for operative pro-cedure, detorsion and fixation in 14 cases (40%), resection anastomosis in 20 cases (57%), and exteriolization in a case were undergone.
Sigmoid volvulus was treated non-operatively in 3 cases and operative cases (87%). As operatively procedure, detorsion and fixation 6 cases (29%), primary resection and anasto-mosis in 3 cases (13%), resection and Hartman´s procedure in 6 cases (29%) and exterioli-zation in 3 cases (14%) were undergone.
10) Seventeen complications in 15 cases of 65 cases of the intestinal volvulus occured. In volvulus of the small intestine, 10 complications in 8 cases occured; 3 wound infections, 2 short bowel syndromes, 1 sepsis, 1 sepsis, 1 adhesive ileus, intraabdominal abscess, 1 pneu-monia, 1 enterocutaneous fistula. In sigmoid volvulus 4 postoperative complications occured wound infection, Sepsis, adhesive ileus, and poeumonia. In compound volvulus postoperative complications were wound in fection sepsis, short bowel syndrome.
11) The motality of intestinal volvulus was 11%.
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