Intestinal volvulus

　　Intestinal torsion is a strangulating intestinal obstruction. The twisted intestinal tract rapidly develops necrosis, perforation, and peritonitis, which is a type of intestinal obstruction with a severe condition and rapid development. If not treated in time, the mortality rate is relatively high (10% to 33%). Intestinal torsion can be divided into primary and secondary types.

　　The etiology of primary intestinal torsion is unclear, and there is no anatomical abnormality. It may be related to the presence of a large amount of undigested contents in the intestinal cavity after a heavy meal, when there is a significant change in body position, the small intestine, due to its weight hanging down, cannot rotate synchronously, causing it to twist.

　　Secondary intestinal torsion is caused by congenital or acquired anatomical changes, forming a fixed point to twist the intestinal loops. However, the occurrence of intestinal torsion is often due to the simultaneous existence of the following three factors:

　　1. Anatomical factors

　　The mesentery of the twisted intestinal loop is too long, and due to congenital development or adhesion contraction, the root of the mesentery is attached to the retroperitoneum too narrowly. Therefore, the common sites are mostly small intestine, transverse colon, sigmoid colon, and mobile cecum. Postoperative adhesions, Meckel diverticulum, long sigmoid colon, congenital incomplete transverse colon rotation, free cecum, etc., are all anatomical factors causing intestinal torsion.

　　2. Physical factors

　　Based on the above anatomical factors, the increase in intestinal weight, volume, and the enhancement of intestinal peristalsis. For example, after a heavy meal, especially with a large amount of indigestible food entering the intestinal cavity; or with a large number of ascaris balls in the intestinal cavity; a large tumor in the intestinal cavity, or a large amount of dried stool accumulated in the sigmoid colon, etc., are potential factors causing intestinal torsion.

　　3. Dynamic factors

　　Strong peristalsis or a sudden change in body position causes the intestinal loops to have asynchronous movements, causing a twisted loop that has a fixed axis position and a certain weight to twist.

　　Intestinal torsion is a strangulating intestinal obstruction, in which the twisted intestinal tract rapidly develops necrosis, perforation, and peritonitis. It is a type of intestinal obstruction with a severe condition and rapid development. If not treated in time, the mortality rate is relatively high (10% to 33%). The common complications are as follows:

　　Intestinal colic

　　Intestinal colic, also known as intestinal spasm, is an intermittent abdominal pain caused by the spasmodic and strong contraction of the smooth muscle of the intestinal wall. It is more common in infants under 3 to 4 months old and is the most common cause of acute abdominal pain in infants. The etiology of this disease is not yet clear and may be related to physical constitution or the incomplete maturation of the central nervous system. The clinical manifestations are characterized by sudden onset of abdominal pain, prominent around the umbilicus, with no abnormal signs during the interval between attacks. The disease often starts in the evening with sudden onset of intermittent abdominal pain. Infants often manifest severe crying, restlessness, flushed or pale facial color around the mouth, sweating, fists clenched, knees bent, cold limbs, and may be accompanied by vomiting. Each attack does not last long, from a few minutes to 10 minutes, and pain may come and go, with repeated attacks lasting for several hours.

　　Intestinal necrosis

　　Intestinal necrosis is also known as acute hemorrhagic necrotic enteritis. It can be caused by many reasons. Once intestinal necrosis occurs, symptoms such as abdominal pain, hematochezia, nausea, and vomiting may appear. Nausea and vomiting often occur simultaneously with abdominal pain and diarrhea. The vomit may be yellow water-like, coffee-like, or bloodwater-like, and it can also be bile. Intestinal necrosis has a sudden onset, with sudden abdominal pain, which can also be the first symptom, usually around the umbilicus. Initially, it often presents with gradually increasing cramping pain around the umbilicus or epigastric area, which then gradually turns into persistent pain all over the abdomen with periodic exacerbation. After the onset of abdominal pain, diarrhea may occur. Initially, the stool is paste-like with faecal matter, which then gradually becomes yellow water-like, followed by clear water-like or red bean soup-like, or jam-like, and even may present as fresh blood or dark red blood clots. The stool is less and has a foul odor. Mild cases may only have diarrhea, or may have positive occult blood in the stool without hematochezia; severe cases may have a blood loss of hundreds of milliliters per day.

　　Intestinal obstruction

　　Intestinal obstruction refers to the obstruction of intestinal contents in the intestines. This disease is a common acute abdominal condition. It can be caused by many factors. At the beginning, the obstructed segment of the intestine has an anatomical and functional change, followed by fluid and electrolyte loss, circulatory impairment of the intestinal wall, necrosis, and secondary infection. Finally, it can lead to sepsis, shock, and death. Of course, if diagnosed and treated in time, most cases can reverse the progression of the disease and be cured.

　　Intestinal volvulus is a closed-loop intestinal obstruction combined with strangulated intestinal obstruction. It has an acute onset and rapid development, with a mortality rate of over 10%, and it should be paid special attention to. The disease starts with severe abdominal pain and marked distension; shock may occur early; symptoms continue to develop and gradually worsen without any intervals. The common sites of intestinal volvulus are the small intestine, sigmoid colon, and cecum. The clinical manifestations vary depending on the site of volvulus:

　　(1) Intestinal volvulus

　　Intestinal volvulus is the most common. It often occurs in young and middle-aged male physical laborers. Before onset, there is often a history of overeating and vigorous activity. The onset is sudden, with persistent severe abdominal pain, and it can be exacerbated periodically; there is initially pain around the umbilicus, which can radiate to the lower back, due to the traction of the root of the mesentery. Vomiting is frequent, and abdominal distension is significant. Early on, there may be tenderness, but no muscle tension, diminished bowel sounds, and the sound of gas passing through water can be heard. The abdominal X-ray film can show different images due to the location of the small intestinal volvulus. When the entire small intestine is twisted, there may be only gas distension and dilation of the stomach and duodenum, but the small intestine can also be generally gaseous with multiple liquid surfaces; when part of the small intestine is twisted, there may be a large amount of distension and expanded loops of intestine in a certain part of the abdomen, with liquid-gas surfaces. Due to the leakage and bleeding in the intestinal and abdominal cavities, as well as the displacement of pathogenic bacteria in the intestines, patients quickly develop hypovolemic shock and septic shock. Generally, only a diagnosis of strangulated intestinal obstruction can be made before surgery, and the situation of the volvulus can be determined during surgery.

　　(2) Sigmoid colon volvulus

　　More common in elderly males. Many have a history of long sigmoid colon or constipation. Patients have persistent abdominal distension and pain, a feeling of lower abdominal坠痛 but without flatus or defecation. There is marked distension in the left abdomen. Intestinal patterns can be seen, and percussion produces a tympanic sound; tenderness and muscle tension are not obvious. X-ray film shows a large, double-chambered, gaseous intestinal loop with liquid levels. This type of sigmoid volvulus is more common and can recur. Some patients have an acute attack, with severe abdominal pain and vomiting; palpation shows tenderness and muscle tension, indicating severe volvulus, obvious intestinal congestion and ischemia. Failure to treat promptly can lead to intestinal necrosis.

　　(3) Cecum volvulus

　　Cecum volvulus is less common. It often occurs in patients with mobile cecum. It can be divided into acute and subacute types. Acute cecum volvulus is uncommon. The disease has an acute onset, with severe pain and vomiting, a mass palpable in the lower right abdomen with tenderness. It can lead to cecum necrosis and perforation. The subacute type has a slightly slower onset, with patients mainly complaining of colic in the lower right abdomen; the abdomen quickly swells, is asymmetrical; an elastic mass can be palpated in the upper abdomen. X-ray film shows a large, gaseous intestinal loop with multiple intestinal gas-liquid levels.

　　Intestinal volvulus is caused by the rotation of a segment of the intestinal loop along the long axis of the mesentery or the twisting of two segments of the intestinal loop into a knot, resulting in a closed-loop intestinal obstruction. Common symptoms include paroxysmal severe colic in the lower abdomen, abdominal distension, and cessation of defecation and flatus.

　　Avoid physical labor immediately after a full meal; especially for labor that requires forward bending and rotation, it has a certain significance for the prevention of intestinal volvulus.

　　Strengthen the publicity of health knowledge, warn people to avoid physical labor immediately after a full meal; patients with habitual constipation, especially the elderly, should try to defecate and develop regular defecation habits; for conditions such as intestinal ascaris, megacolon, and others, early treatment should be given.

　　Intestinal volvulus is a closed-loop intestinal obstruction combined with strangulated intestinal obstruction. It has an acute onset and rapid development, with a mortality rate of more than 10%. It should be paid special attention to. In diagnosis, it can be confirmed by clinical manifestations and laboratory examination. All patients with acute intestinal obstruction should consider the possibility of this condition, and X-ray examination can confirm the diagnosis. The specific examination is as follows:

　　(1) Laboratory examination:

　　Hemoglobin and white blood cell count can be normal in the early stage. When signs of dehydration appear, blood concentration and increased white blood cell count may occur. Abnormalities in serum electrolytes, carbon dioxide binding capacity, blood gas analysis, and blood urea nitrogen may be found. Serum inorganic phosphorus, creatine kinase, and isoenzymes may also show elevation.

　　(2) X-ray examination:

　　Intestinal volvulus: Abdominal X-ray examination shows the characteristics of strangulated intestinal obstruction. In addition, there are specific signs such as displacement or arrangement of jejunum and ileum into various shapes of small-span coiled loops.

　　Sigmoid colon torsion: X-ray barium enema often does not exceed 500ml before it can no longer be infused. Examination shows that barium is blocked at the site of torsion, and the tip of the barium shadow is in the shape of a 'bird's beak'.

　　Patients with intestinal torsion should fast from food and water during an attack, relying on intravenous fluid nutrition support treatment. After treatment, when clinical symptoms are relieved, attention should be paid to diet:

　　(1) Suitable foods:Be sure to keep it light. Eat more foods rich in vitamins, such as green vegetables, carrots, and fruits.

　　(2) Dietary taboos:Avoid binge drinking and eating, ban large fish, meat, oil, high-fat, and high-cholesterol foods (such as animal internal organs, fish roe, crab roe, egg yolk, etc.), fried and fried foods, and oil-rich pastries and alcoholic beverages.

　　The diagnosis and treatment of intestinal torsion in traditional Chinese medicine should be combined with the patient's physical condition, differentiate symptoms and treat accordingly, and the treatment methods are as follows:

　　1. Ascaris colon obstruction

　　Symptoms: Episodic abdominal pain, relief without pain, palpation of the abdomen feels a mass, soft and not firm, or with a feeling of string-like objects, vomiting food or water, or accompanied by vomiting of worms, constipation, red tongue, thin yellow fur, wiry and slippery pulse.

　　Treatment method: Expel worms and promote defecation.

　　Main formula: Compound Daxingqi Decoction

　　Additions and subtractions: commonly add magnolia bark, black plum, cocklebur, and areca nut.

　　2. Heat-toxin accumulation in the intestines

　　Symptoms: Sudden, severe abdominal绞痛, resistance to palpation, abdominal distension, nausea and vomiting, vomiting mostly food, even vomiting feces, intestinal noise, constipation, flatulence, thirst, irritability, red tongue, thick greasy or yellow and dry fur, deep and real pulse.

　　Treatment method: Clear heat and promote defecation.

　　Main formula: Daxingqi Decoction

　　Additions and subtractions: if fire toxicity is severe, add Lonicera, Taraxacum, Patrinia, Moutan bark, Red peony root, and raw earth; if there are signs of blood stasis, add Moutan bark, Red peony root, peach seeds, and Salvia miltiorrhiza.

　　3. Intestinal blood stasis syndrome

　　Symptoms: Severe abdominal distension and pain, the pain location is not moving, resistance to palpation, or palpating a mass, frequent vomiting, constipation or passing bloody mucus, purple tongue with spots, wiry and涩脉.

　　Treatment method: Promote blood circulation and remove blood stasis, relieve constipation and remove retention.

　　Main formula: Taoren Chengqi Decoction

　　Additions and subtractions: fever, thirst, remove cassia twigs, add Coptis, Lonicera, and Moutan bark.