Volvulus: an often missed surgical emergency
A volvulus is where an area of the intestine or bowel twists on itself, which can cause blockage and abdominal pain, a feeling of twisting in the abdomen, nausea, retching, vomiting and reduced or absent bowel motions. Critically however, in the early stages, this does not adversely affect the blood supply to the section of bowel or the blood supply is only slightly reduced.
An abdominal CT scan is the definitive test to rule out or confirm an intra-abdominal problem such as volvulus. If a volvulus is identified, this represents a surgical emergency.
If a diagnosis of volvulus is made early, urgent surgery (either laparoscopic or open) can be performed to untwist the bowel, restore the blood supply and anchor the bowel to prevent further twisting. Alternatively, surgery can resect part of the bowel and rejoin the two ends (anastomosis).
However, if diagnosis of volvulus is missed or delayed, the degree of twisting of the bowel increases and the blood supply to the section of bowel is progressively compromised. This results in the bowel becoming increasingly ischaemic. The twisting also causes bowel obstruction and the bowel distends, worsening the ischaemia. A patient's symptoms become worse with very severe abdominal pain, abdominal distention, severe vomiting (sometimes bile), absent bowel motions and they will feel extremely unwell.
Delayed treatment of a volvulus can cause the patient to suffer from bowel perforation, peritonitis, sepsis and multi-organ failure. Ultimately, if the ischaemic bowel is not treated in time, the patient can potentially die.
When treatment of a volvulus is delayed and a section of the bowel is ischaemic (dead) a patient may require extensive resection of the bowel and the need for an ileostomy (or stoma) which may or may not be reversed in future. They are likely to require admission to Intensive Care and have a protracted recovery. They may never recover to their pre-injury level of functioning.
Ongoing symptoms following treatment of the volvulus can be frequent loose bowel motions or diarrhoea, faecal incontinence, increased risk of intra-abdominal adhesions and bowel obstruction, food intolerances, malabsorption and nutritional problems, fertility problems (particularly in female patients), chronic fatigue and psychiatric illness such as PTSD. In cases where a very significant amount of bowel is resected, a patient can suffer with 'short bowel syndrome'.
Helen Thompson previously acted for a young woman who suffered a caecal volvulus while in hospital following an unrelated surgical procedure for rectal prolapse. In that case, diagnosis and treatment of the volvulus was delayed by several days, which resulted in the client becoming critically unwell with peritonitis and requiring almost two metres of bowel to be removed. The client continued to suffer with life-changing symptoms. In that case, we achieved settlement of £1.9m.