Intestinal volvulus

　　The occurrence of intestinal volvulus is often related to the following factors:

　　1. Anatomical factors

　　The mesentery of the small intestine is relatively long while its attachment point is relatively narrow, making the axis of the small intestine relatively unstable. During malrotation of the middle intestine, the mesentery has not been fixed to the posterior abdominal wall and hangs relatively freely from the mesentery, which is prone to cause intestinal volvulus.

　　2. Physical factors

　　Vigorous exercise after a full meal, sudden change in body position, and other factors can easily lead to intestinal volvulus.

　　3. Intestinal dysfunction

　　Dysfunction of the intestinal function, especially severe abnormal intestinal peristalsis, is also one of the factors leading to intestinal volvulus.

　　In addition to its clinical manifestations, intestinal volvulus can also cause other diseases. In the later stage of the disease, ascites, peritoneal irritation signs, and shock may occur, so it should be highly emphasized by clinical doctors and patients.

　　Intestinal volvulus manifests as acute mechanical intestinal obstruction symptoms, often with triggering factors such as vigorous activity after a full meal. The disease often occurs in children and is often related to congenital malrotation of the intestines. Patients present with sudden onset of severe abdominal colic, usually around the umbilicus, often persistent pain with exacerbation. Abdominal pain often involves the lumbar and back area, and patients often dare not lie flat on their back, preferring to assume a chest-knee position or curled side-lying position. Patients often vomit frequently, but early abdominal distension is not obvious, tenderness is mild, and there is no obvious abdominal muscle tension or rebound pain. With the passage of time, abdominal distension becomes obvious and gradually worsens.

　　In the prevention of small bowel torsion, it is necessary to strengthen health education, avoid physical labor immediately after a full meal, and for patients with habitual constipation, especially the elderly, efforts should be made to defecate and develop regular defecation habits. For conditions such as enterobiasis and megacolon, early treatment should be given.

　　The auxiliary examinations for small bowel torsion mainly include the following types:

　　1. Abdominal X-ray Film

　　The X-ray film shows general distension of the small intestine and multiple liquid levels, and sometimes pseudo-tumor signs can be seen. If the entire small intestine is twisted, it may only show distension of the stomach and duodenum, with不明显 or only occasionally seen small liquid levels.

　　2. Selective Mesenteric Angiography

　　Generally, angiography is not used for the diagnosis of small bowel torsion, and selective superior mesenteric artery angiography is occasionally performed for other reasons. If there is no spasm in the artery or obstruction, the artery can be seen to twist into a circle with the mesentery.

　　3. CT Scan

　　Typical small bowel torsion shows a closed-loop intestinal obstruction. The intestinal tract in the loop is dilated, with obvious gas and liquid levels.

　　4. Blood Routine

　　The examination shows a significant increase in white blood cells, which may be a stress response caused by intestinal ischemia spasm.

　　Patients with small bowel torsion should eat food to prevent infection, such as liquid food and food rich in high-quality protein. In addition, patients should also pay attention to avoid eating foods that are easy to produce gas, such as sweet potatoes, onions, soybeans, and avoid eating greasy, spicy foods.

　　Non-surgical therapy can be tried first for small bowel torsion in the early stage of the disease, but in most cases, especially when the illness is severe or there is peritoneal irritation, surgical treatment should be taken in a timely manner.

　　1. Non-surgical Treatment

　　In addition to routine gastrointestinal decompression, correction of water, electrolyte and acid-base balance disorders, and the use of antibiotics and other basic treatments, massage therapy can also be selected.

　　2. Surgical Treatment

　　For patients with severe illness, with peritoneal irritation sign or ineffective for non-surgical treatment, early surgery should be performed after active preoperative preparation. The surgical methods include small bowel torsion reduction and intestinal resection and anastomosis.