Cecum volvulus

　　Sigmoid volvulus is related to the elongated mesentery and excessive mobility of the sigmoid flexure of the colon. Congenital bands or abdominal surgery adhesions, chronic constipation, distal obstructive lesions, and pregnancy may also be promoting factors. A closed loop strangulated bowel obstruction can form when the twist reaches 270°.

　　Sigmoid volvulus is prone to complications such as intestinal necrosis, and patients are often elderly, so the mortality and recurrence rate are high. Therefore, timely and correct diagnosis and treatment of this condition is the main key to reducing recurrence and mortality rates. In severe cases, the abdomen may show asymmetrical swelling and irregular distension of the intestinal loops, and if they cannot be复位 promptly, the distended intestinal loops may cause intestinal wall necrosis, perforation, peritonitis, and even death due to intestinal strangulation.

　　Sigmoid volvulus has an acute onset, presenting as acute mechanical bowel obstruction, with symptoms such as intermittent colicky pain in the upper abdomen, significant distension, mild vomiting, onset later, and possibly without defecation or flatus.
　　Abdominal examination shows asymmetrical distension, palpable distended and tender loops of intestine in the upper abdomen, percussion sounds like tympany, early hyperactive bowel sounds, and the sound of water passing through. Some cases may have a slow onset and can present with recurrent episodes, with symptoms not very prominent.

　　To prevent the occurrence of sigmoid volvulus, it is necessary to have a regular diet in daily life, to have three meals a day at regular times and in appropriate quantities, not to be overly hungry, and not to overeat or undereat. This is conducive to the balance of intestinal digestion and to avoid intestinal dysfunction caused by uncontrolled diet. In addition, attention should also be paid to the following aspects:
　　1. The diet should follow the basic principles of lightness, easy digestion, and less greasiness. It is advisable to eat foods that strengthen the spleen, such as yam, mung beans, lotus seeds, lilies, jujubes, and so on.
　　2. Eat less cold drinks and less gas-forming food, such as watermelons, cantaloupes, chives, onions, garlic, fried foods, coffee, carbonated drinks, and so on.
　　3. Eat less high-fat food to avoid exacerbating gastrointestinal burden due to its difficulty in digestion, such as eating less high-fat fast food.
　　4. Avoid excessive alcohol consumption.
　　5. Do not consume too much fibrous food every day, and you can choose whole wheat products, as well as citrus fruits, spinach, carrots, and so on.
　　6. Avoid allergenic foods. If you find that you have a similar reaction every time you eat a certain food, be careful to see if you are allergic to it, and you can choose other foods to replace it.

　　The abdominal X-ray or plain film of sigmoid volvulus shows a large amount of gas in the colon, a massive air-fluid level in the upper abdomen, and barium enema shows obstruction at the site of the sigmoid colon with a beak-like shadow.

　　After a few days of fasting after transverse colon volvulus surgery, when it is possible to eat, the diet should be rich in nutrition and properly matched.
　　1. Do not overeat at each meal.Firstly, give liquid diet (generally 6-7 meals a day, food made into fluid, easy to digest and swallow, such as milk, soy milk, rice porridge, rice gruel, meat juice, vegetable juice, fruit juice, etc.), and then gradually change to semi-liquid diet (generally 5 meals a day, food in semi-liquid form, such as congee, noodles, wontons, steamed eggs, minced meat, tofu, vegetable minced, etc.).
　　2. Provide sufficient calories.After gastrointestinal surgery, if the early intake of calories is insufficient, negative nitrogen balance and weight loss will occur, and intravenous nutrition should be supplemented when necessary. As the gastrointestinal function of the patient recovers, gradually increase the oral intake of high-calorie diet, such as milk, desserts, eggs, chocolate, fruits, etc.
　　3. Supplement high-protein diet.Protein deficiency can cause tissue edema, affect healing, and cause the patient's weight to decrease and the infection rate to increase. Therefore, patients with gastrointestinal surgery should supplement high-protein diet, choose easily digestible foods with high amino acid content and a variety of types, such as meats, fish, eggs, milk, beans, etc.

　　The treatment principle of acute transverse colon volvulus: maintain electrolyte balance, use antibiotics to improve the overall condition, perform emergency surgery to resect the proximal part of the volvulus of the transverse colon and perform colostomy to relieve intestinal obstruction.

　　1. Partial resection of the transverse colon and primary anastomosis
　　When the vitality of the transverse colon is good after partial resection of the transverse colon and primary anastomosis after reduction of volvulus, and the patient's general condition is good, the resection of the volvulus segment should be performed, and primary end-to-end anastomosis should be performed. Simple fixation of the transverse colon has a high recurrence rate, so it should not be adopted. If the distance between the two ends of the transverse colon cannot be anastomosed, it is necessary to resect the right half of the colon, and perform primary ileum and left transverse colon anastomosis.

　　2. Partial resection of the transverse colon and colostomy at both ends of the colon
　　After the reduction of colonic volvulus, if there is ischemia or necrosis of the colon, infection in the abdominal cavity, or general condition is poor, it is not advisable to perform primary anastomosis after the resection of necrotic colon, and it is possible to perform two-stage anastomosis by separately performing colostomy on both ends of the colon.

　　Colonic volvulus is prone to complications such as intestinal necrosis, and patients are often elderly, so the mortality and recurrence rate are high. Therefore, timely and correct diagnosis and treatment of this condition is the main key to reducing recurrence and mortality rates.